Thursday, November 22, 2012

Industry Experts Explain 3 Methods to Reduce Hospital Readmission (Part 1)

Fines for high readmission rates have been punishing some of America’s hospitals since October first. Many experts in the industry have been working to find solutions to what has become one of the most prevalent issues faced by health facilities today.

Andrew Seaman, with Reuters, suggests that social factors, outside of the reach of any hospital, may be contributing more than CMS is willing to admit.

But CMS does not consider so-called social factors, such as a patient's living situation or low income, when profiling the quality of a hospital's care.

In the new study, published in the Journal of General Internal Medicine, researchers analyzed data from 72 previous papers examining the reasons people died or were readmitted to the hospital, and found that age, race, employment status, living situation, education and income levels are just some of the factors that may play a role.

"We don't yet know how to accurately measure (the factors), but I think we found enough information to say that they are important and that they should continue to be studied and accounted for," said lead author Dr. Linda Calvillo-King, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas.
In the Reuters article, Calvillo-King explains that too many factors outside of a hospital’s control -- such as whether or not a patient follows prescription instructions -- are leading to readmission penalties.

Alternatively, in a recent NPR report, Dr. Julie Ann Sosa, of the Yale School of Medicine, believes that patients are simply being released too early after surgery.

"We live in an era where there is a pressure to discharge and to expedite care and make health care more efficient," says Dr. Julie Ann Sosa, a surgery professor at the Yale School of Medicine who co-authored the study. "Some of these complications in the past may have occurred while patients were still hospitalized. Now they occur at home."

Sosa and her colleagues analyzed a database of more than 500,000 patients who underwent surgery from 2005 through 2010. The researchers found that the most common surgical complication patients experience after leaving the hospital is a localized infection at the site of the incision…

…More than 40 percent of all patients who experience complications after surgery experience them at home, according to a study in the journal Archives of Surgery. Half of those complications occur within nine days of patients leaving the hospital.

Next week, we’ll continue delving into these topics, and will open the floor to suggestions on how hospitals should be changing to meet CMS guidelines, or if those guidelines are even plausible.


Pam Argeris is a thought leader in the Healthcare Industry and possesses extensive, hands-on experience with CMS compliance, and multiple regulatory bodies such as NCQA, JACHO, and DOI. In her role at Merrill Corp., Pam focuses on developing solutions for compliance and quality assurance, delivered in a cost effective manner to improve beneficiary and prospect communications. You can contact Pam at

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