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Pushing Hospitals To Reduce Readmissions Hasn't Increased Deaths

Greenbeard

Greenbeard

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Well, that's good news. One of the ACA's most visible policy successes (after the flashier coverage expansion stuff) seems to have worked out for patients.

Pushing Hospitals To Reduce Readmissions Hasn't Increased Deaths
The Affordable Care Act sought to make all of that happen by changing hospital incentives. Hospitals with higher than average readmission rates would be penalized financially. These penalties began in 2012 and have increased over time.

With these new incentives in place, and some investments by Medicare to help places with the highest readmission rates, hospitals across the country have focused on improving care for patients as they transitioned from the hospital to home. More attention was placed on ensuring the inpatient and outpatient medication lists matched. Hospitals found ways to integrate caregivers and family members in the discharge planning. They scheduled follow-up visits after discharge and improved communication between the hospital and outpatient teams.

With these changes, readmission rates dropped dramatically across the nation. Rates declined almost 20 percent for patients hospitalized with heart attacks, heart failure and pneumonia, the conditions included in the Affordable Care Act. Readmission rates also declined for many other conditions not specifically targeted in this part of the Affordable Care Act, though to a lesser degree. In total, hundreds of thousands of patients avoided a return to the hospital.
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After studying more than 6 million hospitalizations from over 5,000 hospitals over a seven-year period, we found no evidence that the reduction in hospital readmissions resulted in greater risk of dying for patients recently discharged.

In fact, hospitals that reduced readmissions the most were, if anything, more likely to reduce mortality after hospitalization. These findings held even for patients with heart failure, who had rising mortality over time as the least sick patients were increasingly treated as outpatients.

How did this happen? To lower readmissions, hospitals needed to better prepare patients and families for discharge and improve the integration and coordination of care from hospital to home. These interventions likely also reduced the risk of death.
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MaggieD said:
Great post. Everyone should be aware of this important change. No more shoving patients out the door. And better preparing patients for discharge? Solid gold.
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Until of course the republicans you elected decide to change all that, especially if they get their repeal of the ACA.
 
Praxas said:
Until of course the republicans you elected decide to change all that, especially if they get their repeal of the ACA.
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Please post your link that a repeal of ACA it also repeals that provision without replacing it elsewhere. Or are you assuming? We know the answer to that already, don't we?
 
MaggieD said:
Please post your link that a repeal of ACA it also repeals that provision without replacing it elsewhere. Or are you assuming? We know the answer to that already, don't we?
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A flat out repeal takes that provision out. Do you think the hospitals will do it out of the kindness of their hearts?
 
Praxas said:
A flat out repeal takes that provision out. Do you think the hospitals will do it out of the kindness of their hearts?
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Why do you assume this legislation is part of the ACA and not part of the suggested replacement?
 
MaggieD said:
Why do you assume this legislation is part of the ACA and not part of the suggested replacement?
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I hope you;re sitting down. I have news for you.

There IS no suggested replacement. It's over. Died yesterday from incompetence and neglect. Sorry to have to break it to you.
 
Threegoofs said:
I hope you;re sitting down. I have news for you.

There IS no suggested replacement. It's over. Died yesterday from incompetence and neglect. Sorry to have to break it to you.
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Yeah, I'll bet that's the end of the story right there.
 
MaggieD said:
Why do you assume this legislation is part of the ACA and not part of the suggested replacement?
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Because at this point there is no replacement only repeal. That is the GOP goal at this point.

Seems you have a gap in what's going on let's refresh your memory. GOP didn't ask for any inputs from dems even though dems asked for inputs from republicans on the ACA. Gop intentions are to repeal and not replace, therefore those provisions you spoke of will be gone under the GOP plan.
 
holbritter said:
That is good. What's sad is hospitals have to be threatened with financial penalty for them to do the right thing by their patients.
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Not sad, but expected, in a for profit system.
 
KevinKohler said:
Not sad, but expected, in a for profit system.
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Any system does it in some way or another. Otherwise costs go towards very high. ;)
Thoughts?
 
joG said:
Any system does it in some way or another. Otherwise costs go towards very high. ;)
Thoughts?
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Aspirin doesn't cost 1 dollar per pill.
 
KevinKohler said:
Aspirin doesn't cost 1 dollar per pill.
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True. But newer treatments of cancer are looking like $ 500.000 per case and there are more expensive ones around.

But hey. With all the research and development there might be a youth pill coming at a dollar that will cure all evil.
 
joG said:
True. But newer treatments of cancer are looking like $ 500.000 per case and there are more expensive ones around.

But hey. With all the research and development there might be a youth pill coming at a dollar that will cure all evil.
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At the expense of complete global annihilation. A cure for death is also an end to life.
 
MaggieD said:
Great post. Everyone should be aware of this important change. No more shoving patients out the door. And better preparing patients for discharge? Solid gold.
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Yeah not happening.

They are still pushing patients out the door. And they aren't preparing patients better for discharge. They are putting more pressure on home health to keep people at home and prevent readmission. The same with nursing homes and assisted livings. If the patient is sent to your care and is doing poorly.. you better deal with it yourself or get punished. In some cases, entities are shipping patients to other hospitals when they need to be readmitted because in order to avoid the consequences from the hospital who threatens to not send them patients.

In one example.. a patient came from the hospital after a hip fracture and orif. When they got to the facility, the therapist there noticed that the patient had a documented fall in the hospital but no follow up x rays. When they went to see the patient.. his hip was shortened and internally rotated (clear sign of hip fracture). They facility transferred that patient back to the hospital and a call was made to the ER physician regarding the patient.

The hospital did not admit them but medicated the man and sent him right back that night.

The next day the therapist went to see the man and he again was shortened and internally rotated. This time the therapist was able to get in touch with the surgeon who met the fellow in the ER when he was sent back to the hospital. Subsequent x rays revealed the man had refractured and he was admitted and had to undergo a total hip.

Three days later he was sent back to the rehab facility.

A month later.. the hospital in their meeting with the facilty explained that because the facility had sent this patient back to the hospital twice.. the facility was going to be downgraded in their scoring system and therefore would now be the last in line to receive patients from the hospital.

True story.

Don't believe the hype on this. hospitals that were performing badly are still doing so if not worse. Hospitals that were doing right by their patients are still doing right by their patients.
 
jaeger19 said:
Yeah not happening.

They are still pushing patients out the door. And they aren't preparing patients better for discharge. They are putting more pressure on home health to keep people at home and prevent readmission. The same with nursing homes and assisted livings. If the patient is sent to your care and is doing poorly.. you better deal with it yourself or get punished. In some cases, entities are shipping patients to other hospitals when they need to be readmitted because in order to avoid the consequences from the hospital who threatens to not send them patients.

In one example.. a patient came from the hospital after a hip fracture and orif. When they got to the facility, the therapist there noticed that the patient had a documented fall in the hospital but no follow up x rays. When they went to see the patient.. his hip was shortened and internally rotated (clear sign of hip fracture). They facility transferred that patient back to the hospital and a call was made to the ER physician regarding the patient.

The hospital did not admit them but medicated the man and sent him right back that night.

The next day the therapist went to see the man and he again was shortened and internally rotated. This time the therapist was able to get in touch with the surgeon who met the fellow in the ER when he was sent back to the hospital. Subsequent x rays revealed the man had refractured and he was admitted and had to undergo a total hip.

Three days later he was sent back to the rehab facility.

A month later.. the hospital in their meeting with the facilty explained that because the facility had sent this patient back to the hospital twice.. the facility was going to be downgraded in their scoring system and therefore would now be the last in line to receive patients from the hospital.

True story.

Don't believe the hype on this. hospitals that were performing badly are still doing so if not worse. Hospitals that were doing right by their patients are still doing right by their patients.
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My experience with my 88-year-old mom, an 82-year-old family friend, and myself . . . Three different hospitals . . . Has been totally different. In all cases, home nursing was arranged by the hospitals at discharge, oxygen was ordered and delivered to two of the homes Day of discharge, and nurses from the hospitals followed up by phone within a few days. Hospitals involved? Alexian Brothers in Elk Grove Village, IL . . . Loyola Hospital in Maywood, Illinois . . . LaGrange Memorial Hospital in LaGrange, IL.

Our experiences are very different.
 
MaggieD said:
My experience with my 88-year-old mom, an 82-year-old family friend, and myself . . . Three different hospitals . . . Has been totally different. In all cases, home nursing was arranged by the hospitals at discharge, oxygen was ordered and delivered to two of the homes Day of discharge, and nurses from the hospitals followed up by phone within a few days. Hospitals involved? Alexian Brothers in Elk Grove Village, IL . . . Loyola Hospital in Maywood, Illinois . . . LaGrange Memorial Hospital in LaGrange, IL.

Our experiences are very different.
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Which was best? Which was worst? And why?

Asking for a friend.
 
Threegoofs said:
Which was best? Which was worst? And why?

Asking for a friend.
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These hospital stays and interactions were either for myself or my mom or a friend. Both of the last two had me as their HCPOA. Because I am a strong advocate for myself and others, I would rate Loyola and Alexian as best. LaGrange in-hospital docs were hard to get hold of.

If you're asking because someone you love is debating on which to go to? I would recommend that, depending on what's wrong with them, they simply use the hospital closest to them...the one they would be taken to if they called 911 from their home.

There are times when procedures are so rare that going to a particular hospital and choosing a particular surgeon is very important because they do x-more of particular procedures than others, but, in my opinion, there are no magic bullets, no secret cures and no reason to travel long distances to get the best care available today.

The caveat to my opinion, however, is that sick people need strong advocates who do some investigating on their own. The internet is our bestie when we are faced with serious illness.
 
MaggieD said:
My experience with my 88-year-old mom, an 82-year-old family friend, and myself . . . Three different hospitals . . . Has been totally different. In all cases, home nursing was arranged by the hospitals at discharge, oxygen was ordered and delivered to two of the homes Day of discharge, and nurses from the hospitals followed up by phone within a few days. Hospitals involved? Alexian Brothers in Elk Grove Village, IL . . . Loyola Hospital in Maywood, Illinois . . . LaGrange Memorial Hospital in LaGrange, IL.

Our experiences are very different.
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With respect.. You are missing my point.

What your mom experience and your family friend experienced? That has been the standard of care for decades Maggie. What you experienced in regard to having o2 delivered on discharge day 1, and home nursing arranged before discharge has been a standard of care for decades. That's not the result of Obamacare.

Lets step back and really think about what the OP is celebrating.

Basically its " OBamacare works.. it hasn;t killed people". I mean yeah.. that's good that mortality rates have not increased. But I would kind of hope that legislation was not put in place that had a real chance of killing more people... wouldn't you?

the point is.. the metric that we are using for success... "look we didn;t kill people".. doesn;t seem to be the best metric of evaluating the effects of healthcare policy.

Certainly we want to know if a policy is causing unnecessary deaths. But there are other questions that we need to ask that we are not asking.. have not been asking.

So a question is : Did your mom to return to her prior functional level compared with prior to these policy changes? If she did, how long did it take.. longer or shorter or the same as befo
Was your mom's pain under control as well when she left the hospital and did she stay under control.. or was she less under control and it take longer to get her pain under control?
Did you mom have less or more complications after leaving the hospital than prior to the policy change?

See Maggie.. we are claiming success with these policies.. but we are not measuring the right metrics to know if there is actually success.

Sure.. we know that we did not kill people. that's great.. but it doesn;t mean that care is better.

We are not readmitting people.. that's great.. but it does not mean that care is better.

In both cases, actual care could be much worse.. just not lead to death,,and just not be dealt with in the hospital on readmission.


Here is an example of why such questions are important. Supposedly we are undergoing an epidemic of opiate use. Now I have questions if its truly and epidemic and its new.. or if its really the result of new definitions of whats considered inappropriate opiate use etc.

But it does beg the question... why the sudden opiate use if its actually occurring.

Well... in the medical field, the use of opiates is a good way to get patients to go away. You have pain.. and we don't want to deal with it and solve the problem... here is some opiates. Its what they did to the patient with the fractured hip.. medicate him with opiates and send him back to the nursing home.

So is what we are seeing? ARe we discharging patients without adequate pain control..or who are experiencing problems/complications out into the community from the hospital and the only answer that physicians have is to keep them medicated?

Are we trying to avoid tests, diagnostics by simply prescribing meds.. or is it a result of simply not having enough time per physician?

It appears to me.. that we are purposely not asking the right questions..and I think its because the policy makers really don't want the answers.
 
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