Your Medicare Rights. Know Them. Use Them. You have the right to appeal your discharge.

Your Medicare Rights. You have the right to appeal your discharge.

What a Difference a Day Makes

Download pdf versions of both parts of the report here.

Executive Summary

Going home after an acute hospital stay presents significant challenges, particularly for seniors. Discharge from the hospital does not mean that the need for care has ended. The critical issue is making sure that after a patient goes home, he or she does not end up back in the hospital in a few days. The rapid readmission of a patient strongly suggests that the return home was medically premature, poorly prepared for, or both. This report argues that the current design of the healthcare system results in a serious waste of financial resources. And this means that patients don’t receive adequate care.

Reducing hospital stays from avoidable readmissions by just one day would save $227,346,788 per year. For a fraction of this sum, we could greatly improve discharge planning and enhance home and community support services. This would result in better outcomes for patients and improved efficiency in the healthcare system. It’s a win-win solution.

The avoidable readmissions issue was highlighted in a 2009 review of over 435,000 Medicare records by Jencks et al. They found that approximately 20% of cases resulted in readmission within 30 days without the patient first seeing a physician.

This report examines the costs and impacts of these avoidable readmissions and recom­mends three key ways to reduce readmissions and save money:

• increase levels of discharge planning staff and improve ways to pay for them

• fund higher levels of community-based long-term care support services that can assist patients in the community when they leave the hospital

• mandate coordination of healthcare services in the community regarding the discharge process

Unneeded increased spending is a part of the readmission picture in two ways: 1) when additional acute care is needed, at an average in California in 2009-10 of $2,205 per day, and 2) in a significant likelihood of increased health problems and additional costs when patients are discharged prematurely or are not prepared to recover at home. The human cost of this issue can be measured in mortality rates and reduced quality of life for as many as 81,000 seniors annually in California alone.

Numerous studies have shown that readmissions can be significantly reduced. Keys to such a reduction are better hospital discharge planning and more closely coordinated community-based support services. The patients served by these improvements will see a dramatically higher quality of life. Equally important, as the analysis below suggests, is that there is already plenty of money in the system to pay for these services. Policymakers and insurers who pay the bills could act and save the healthcare system from itself.

The charts at the end of the report illustrate exactly how much money could be redirect­ed to discharge planning and community support services. Statewide, roughly 4.5 million Californian seniors are covered by Medicare, and the Medi-Cal program pays a significant share of the cost for approximately 1.1 million “dual eligibles” (people covered by both Medicare and Medi-Cal), including the vast majority of nursing home residents.

This report argues that reducing the level of readmissions could substantially reduce costs to both programs and provide a major source of funding for improved discharge plan­ning and in-home services in the community, as described below:

Cutting Hospital Stays from Readmissions in California by Just One Day
Program	Annual Savings	Full Time Discharge Planners that could be Hired with Cost Savings	Home Care Workers that could be Hired with Cost Savings
Medicare	$179,200,350	3,746 Full Time Positions	14,933,360 additional hours
Medi-Cal	$48,146,438	1,012 Full Time Positions	4,068,344 additional hours

It's Scary to be Discharged on a Friday

This skit demonstrates how a person on Medicare can appeal their hospital discharge plan, demand their rights and save their life. Every state has a QIO, or Quality Improvement Organization that monitors hospitals and doctors that bill Medicare. There are rules hospitals must follow. For example, they must notify you in writing 48 hours in advance of your discharge. These are federal rules that hospitals are legally required to follow. Don't leave the hospital until you are ready. Know your rights!

San Francisco Homecoming Services Network

If you are in San Francisco and need help transitioning from the hospital to home, or if you are a social worker or discharge planner who needs help making sure clients get everything they need, contact Homecoming Transitional Care Program.

Hospital Discharge Stories

Go here to share your hospital story:
TELL US YOUR HOSPITAL STORY

Personal stories are a critical part of organizing communities and putting a personal face to a policy problem or service gap. Therefore, we encourage all seniors, adults with disabilities, caregivers and service providers to record your personal stories, especially about issues (good or bad) related to homecare and discharge planning.

 HAVE YOU BEEN TO THE HOSPITAL?

• How were you treated?

• Did you get everything you needed when you were discharged?

• Did a discharge planner or nurse talk to you about what services you would need when you returned home?

• Did you understand the discharge planning process?

• Did you feel anxiety about leaving the hospital?

• What would you change about your experience?

• Do you have everything you need now?

The California Discharge Planning Collaborative wants to hear from you!
We want to hear your story!
We are collecting testimonies from people who were (or are) hospitalized in San Francisco and California.

• Help to improve discharge planning policy.

• You can submit your story in writing, in person or over the telephone. All information is strictly confidential.

Call James at (415) 703-0188 ext 304 or james@planningforelders.org, visit the link at the top of this post "TELL US YOUR HOSPITAL STORY', or just write it below.