Reducing hospital re-admissions and bouncebacks isn’t easy

In their most recent piece at Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines tackle the issue of bouncebacks.  That is, the re-admission of recently discharged hospitalized patients.

They bring up good some good points, and point out that, until recently, hospitals really didn’t have any incentive to reduce bouncebacks:

… hospitals have never had a compelling reason to try to prevent bouncebacks. Hospitals are typically paid a flat sum for each inpatient stay—shorter stays equal higher profits. When patients bounce back, hospitals can charge the insurance company twice for the same patient with the same problem. Many hospitals also view bouncebacks as out of their control: If a patient boomerangs back because she doesn’t follow doctor’s orders, it’s not the hospital’s fault.

With health reform, however, things are changing.  In an effort to reduce bouncebacks, hospitals are paid less for re-admissions, and they must publish their bounceback rates.

But there are problems in the zeal to reduce bouncebacks  First, bad care isn’t necessarily responsible for every case.  A patient’s brittle underlying medical condition, for instance, may be responsible.

And second, steps to reduce re-admissions aren’t all proven to work.  The authors cite a study showing that improved follow-up only minimally affected the bounceback rate.

I agree with the authors that it’s probably in everyone’s best interest to reduce re-admissions.  The question is how to do it.  Increase primary care access?  Improve discharge processes?  Those steps are already taken into account and being continually improved.

One interesting idea is having hospitalists provide the follow-up themselves.  After all, they’re the ones that best know the hospital course.  Some programs have their hospitalists do transition care clinics, improving the bridge between hospital discharge and primary care.

I’m not sure of the outcome data surrounding this practice, but it’s one underpublicized idea that may be worth exploring.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

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