Monday, April 11, 2011

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

 
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