Posted 10/24/11 on Not Running a Hospital
If you had asked me to predict which topic on this blog would generate acrimony and criticism, I would have been hard-pressed to guess that it would have been hospital readmissions. Recall that I expressed objections to the use of financial penalties to persuade hospitals and doctors to reduce this phenomenon. Also, I cited a paper that showed that the data do not exist to fairly and accurately implement such a penalty scheme. I followed this with a post citing an article suggesting that such penalties might especially adversely affect lower income hospitals. Then, I suggested the kinds of questions that should be answered as we consider any type of public policy change.
Continue reading “Harold Miller Offers Advice on Hospital Readmissions”
Posted 10/19/11 on The Hospitalist Leader
Two important review papers are out this week (state of the art) and deserve mention in the blog. They both dovetail nicely, and serve as bookends in our approach to readmission management.
One examines RISK of patient readmission, and the other reports INTERVENTIONS to prevent it. Unfortunately, the literature falls short on both counts.
Assessing discharge recidivism rates is dicey at best, and given the state of evidence, again, we are called upon to correct a systemic problem—one with multiple causes—with unsatisfactory tools. This frustrates not just hospitalists, but the health system at large given the uneven progress in improving this metric.
If we cannot predict who will return to the hospital, or choose proper interventions, performance ranking and penalties are premature. A recurring theme, the same concern exists with standardized mortality ratios (SMR). Moreover, if there is any doubt as to assessments in that realm, this citation is sobering. The horse has left the barn however; we are stuck, and resistance is futile.
Continue reading “Readmissions Revisited…Again. With New & Improved Data!”