Hospital Readmissions: Federal Policy Must Stop Interfering with System Thinking
by Cary Gutbezahl, MD

Failed Thinking

There has been much recent attention to the high cost associated with readmissions. It seems clear that the policy makers are seeking to hold hospitals responsible for preventing readmissions. Holding hospitals accountable is a classic example of failed “management-thinking” where the absence of facts is filled by assumptions.

Who is Really Responsible?

In my case management experiences, both in hospitals and in managed care organizations, I have found many reasons why patients are readmitted to hospitals. These include medical reasons such as a complication or instability of the disease; patient reasons such as lonely people who don’t want to stay at home alone or patients who don’t want to eat a low-salt diet; and post-hospital care provider issues such as nursing homes that are short-staffed and want to send “sick” patients back to the hospital. All of these are not single solution problems. The only clear fact is that hospitals are not alone in causing these problems.

So, how can the hospital be held responsible for all this?

Easy Targets Aren’t Right Targets

Hospitals are an easy target. Other more realistic solutions such as holding patients and their families responsible for unnecessary readmissions are harder to implement or not politically acceptable.

Financial Incentives Limit Stay Time – and Care

The public does not realize that Medicare, under current regulations, does not pay for long hospitalizations. In fact, the DRG payment system creates financial incentives to shorten hospitalizations and creates financial penalties to hospitals that have long hospital lengths of stay. Medicare also wants patients to go home (without home nursing care) rather than to a nursing home. Medicare is no more compassionate than any other insurer.

Complicated Responsibilities

Medicare also requires that hospitals provide patients with a list of post-hospital care providers and expects the patients to choose. Hospitals cannot, by regulation, indicate preference to their own home care company.  Doesn’t this further complicate the degree of responsibility that a hospital can reasonably assume for rehospitalization?

How to Provide Better Continuity of Care?

If this unreasonable penalty against hospitals is implemented, Medicare should allow hospitals to refer patients to their own nursing facilities and home health care agencies. This will provide better continuity of care and enable the hospital to be a true health system responsible for providing a wider scope of services to patients in their community.