If you want to keep patients from returning to the hospital, you should aim to keep them out in the first place, a new study suggests.
Medicare has been focusing on readmissions—when patients return to the hospital in the first 30 days after leaving—as a sign of poor-quality care. Beginning next year, the government will begin penalizing hospitals that have high rates of repeat customers.
It is also funding a series of pilot studies that look at actions hospitals can take before and after discharge to make sure that patients understand their treatment plan and have the resources they need to stay healthy after they leave. Several studies have shown that such planning can drive down readmission rates.
But the new study, in the New England Journal of Medicine, shows that such measures do less to predict readmissions than another, less targeted measure: the rate of hospital use overall. According to Dr. Arnold Epstein, Dr. Ashish Jha, and John Orav, all of the Harvard School of Public Health, hospitals that are inclined to admit patients more often appear inclined to readmit patients more often too.
“Although most interventions designed to reduce readmissions thus far have focused on better disease management and the coordination of care, our results underscore the importance of policy efforts directed at reducing the general incentives to use hospital services,” they wrote.
The researchers don’t dispute the benefits of encouraging hospitals to help patients plan for life after hospitalization. But they suggest that Medicare and other payers consider financial arrangements that reward health care providers for keeping patients out of the hospital altogether.
“I think the notion that we can do better at the point of transition are pretty obvious, but I think what this is saying is that it’s really just a start of what we have to do,” Epstein said in an interview.
Epstein said the paper points to regional cultures, where some communities of physicians are more inclined to send patients to the hospital when things go wrong, while others try harder to manage their health from home.
Medicare is also experimenting with payment programs that reward providers for coordinating care and holding down health care costs, through so-called Accountable Care Organizations and other measures. The study suggests that these efforts have promise. The researchers recommend different payment schemes that would reward hospitals for serving populations, not just for offering more treatments.
Gail Wilensky, a senior fellow at Project HOPE who led Medicare and Medicaid during the first Bush administration, said the paper underscores how important it is for policy makers to focus on financial incentives aimed at reducing hospitalizations.
“If there is a way to keep people out of the hospital in the first place, by other interventions--through nurse contact, or keeping people properly on their medications, or whatever--it not only lowers the high cost of a first hospitalization but is associated with rehospitalizations as well,” she said.