Beginning November 2012, the federal government will impose penalties on hospitals that have excessive patient readmissions. A hospital readmission is when a patient is discharged and then readmitted shortly thereafter because of a condition or complication related to the first admission. Under the Patient Protection And Affordable Care Act, if hospital readmissions become excessive, the federal government considers this a type of medical mistake. In an effort to avoid excessive and unnecessary healthcare costs, the federal government will no longer provide medical reimbursement to health providers that have excessively high rates of readmission.
So how will these federal penalties on excessive patient readmissions improve patient care and reduce the rate of medical malpractice? The answer seems to be yes. According to patient care advocates and at least some hospital administrators, these government penalties will force hospitals to take long overdue steps designed to improve patient safety. By penalizing hospitals for excessive hospital readmissions, doctors will be have to reexamine how they evaluate whether a patient is truly ready for discharge. This requires that doctors be accurate in their diagnosis before discharge and accurate in their assessment of the patient's condition at discharge.
Regarding diagnosis, some patients are misdiagnosed at or before discharge. As a result, the patient will return to the hospital because the treatment plan does not fit the patient's actual condition. Improving the accuracy of patient diagnosis will reduce the rate of unnecessary hospital readmissions. Regarding patient assessment at discharge, many hospital readmissions stem from discharging a patient when they are not in stable condition. While at home, the patient's condition worsens. As a result, the patient is taken back to the hospital, often, with an even greater medical problem than existed any time before discharge. Implementing hospital policies and procedures designed to more accurately assess a patient's condition just before discharge will also reduce the number of hospital readmissions.
In addition to properly determining the patient's diagnosis and condition just before discharge, hospitals should also reexamine how they coordinate patient care at discharge with the family provider or nursing home provider. After all, some hospital readmissions occur because post-discharge instructions are either unclear or incomplete on how others should manage the patient's care at home or in the nursing facility. As a result, the patient's condition unnecessarily deteriorates requiring readmission to the hospital. With these and other policy improvements, hospitals should see a reduction in the number of needless hospital readmissions.
New Observer, Hospitals Scramble To Limit Readmission, Avoid New Penalties, November 24, 2012.