Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Reducing hospital readmissions from the emergency department

Myles Riner, MD
Policy
July 6, 2014
54 Shares
Share
Tweet
Share

All of the focus that CMS is putting on hospital readmissions via the Readmissions Reduction Program, and the financial penalties that readmissions can generate, is causing hospital administrators to look to the emergency department and emergency physicians to intervene and resolve the issues that interrupt recovery for post-hospitalization patients.

In today’s world of budget-constrained financing of government health care programs and narrow hospital margins, the question of how best to mitigate the need for readmission is as uncertain as it is important. Some recent studies cast a bit of light on the question, and bloggers like Jordan Rao in the Incidental Economist have taken note. In this post, Rao notes that “readmissions are down … to what extent can that be explained by an increase in ED visits that don’t result in an admission?”

readmissions-300x232

In the same blog, Austin Frakt questions whether the trend is really a reflection of better care or of gaming the measure, or both. Certainly, aggressive ED intervention or observation care can fend-off the need for inpatient readmission; but I can tell you from the experience of a family member who bounced from hospital to ED to SNF to ED to SNF to ED until definitive surgical care was finally provided, that preventing readmissions in this way does not necessarily imply better care.

A recent study of 15,519 inpatient discharges from a large safety net hospital published in the Annals of Emergency Medicine concluded that, “Excluding a return to the ED misses more than 50% of all returns to the acute level of care after discharge.”

What happens if Medicare decides, as seems inevitable, to count and ding hospitals for ED visits within 30 or 60 days of hospital discharge (presumably for issues related to or precipitated by the inpatient stay)?  Will this new accounting measure suddenly cause hospital administrators to shift the role of readmission-blocker from the ED to other services, and likewise reallocate resources like care coordinators and social services staff that may have been moved into the ED to assist in this role? It seems like the regulatory tail may be wagging the health care best-practice dog; and the evidence base for the economic value of these incentive/penalty based regulatory initiatives is very lean.

In fact, the cost-effectiveness of all sorts of care management tools that are being employed to curtail readmissions is still uncertain. There is even a question as to the effectiveness of community health worker intervention on health outcomes and resource utilization, as related in a 2013 report by the New England Comparative Effectiveness Public Advisory Council on Community Health Workers in New England and shown in the following graphic.

CHW-interventions-300x202

Given that the rate of readmissions seems to be significantly dependent on the socio-economic status of the patient, is it fair to disproportionately penalize safety-net hospitals for circumstances that may be beyond the control of these hospitals, even when they invest in community care resources and close post-discharge follow-up? I suspect that the most cost-effective approaches to preventing readmissions are those that are executed during the hospitalization, and are tailored to the specifics of the patient’s health care and social services needs, and to the nature of care provided.

I would argue that trying to prevent readmissions post hoc may or may not lead to better inpatient care and post-operative outcomes, even though it seems intuitive that such a reduction should save health care expenditures (given the costs of hospital care).

However, if by enhancing recognition of the role of EDs and emergency physicians and staff in circumventing readmissions, the Readmission Reduction Program has encouraged hospitals to add discharge planning, social services, and care coordination staff and resources into the emergency department, I am all for it. These resources have, for far too long, been limited or absent from most EDs, to the detriment of many of the patients treated there.

Myles Riner is an emergency physician who blogs at The Fickle Finger.

Prev

3 innovations to improve mental health treatment

July 6, 2014 Kevin 14
…
Next

What kind of doctor are we breeding in medicine now?

July 7, 2014 Kevin 8
…

Tagged as: Emergency Medicine, Hospital-Based Medicine

Post navigation

< Previous Post
3 innovations to improve mental health treatment
Next Post >
What kind of doctor are we breeding in medicine now?

More by Myles Riner, MD

  • Sooner or later, you will need the ER. Will it be there?

    Myles Riner, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Ebola and the psychology of contagious disease

    Myles Riner, MD
  • a desk with keyboard and ipad with the kevinmd logo

    How to solve the SGR gridlock

    Myles Riner, MD

More in Policy

  • Pediatricians grapple with guns in America, from Band-Aids to bullets

    Tasia Isbell, MD, MPH
  • Health care wins, losses, and lessons

    Robert Pearl, MD
  • Maximizing care amidst provider shortages: the power of measurement-based care

    Tom Zaubler, MD
  • Unveiling excessive medical billing and greed

    Amol Saxena, DPM, MPH
  • Chronic health issues and homelessness

    Michele Luckenbaugh
  • The impact of certificate of need laws on rural health care

    Jaimie Cavanaugh, JD and Daryl James
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Exploring disfigurement and self-worth

      Kathleen Watt | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • CDC Advisors Endorse Maternal RSV Vax to Protect Newborns
  • Amoxicillin Alone for Acute Sinusitis Holds Up Against Broad-Spectrum Cousin
  • Despite Taboo, Med Students, Doctors Use Substances Too
  • White House Opens Gun Violence Prevention Office
  • Nurses Step Up to Bat on Educating Patients About Climate Change

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Exploring disfigurement and self-worth

      Kathleen Watt | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Reducing hospital readmissions from the emergency department
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...