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.
To me, this is the kind of straightforward discussion and debate that occurs on a variety of health care issues. Who would have thought that this might bring an accusation of "willful stupidity" and a complaint that "you have shown yourself even more opposed to universal healthcare than this relatively easy, low cost way to improve outcomes"?
The more serious commentators, though, asked, "What would you do?" My general answer, as many of you know, is that a focus on quality and safety and clinical improvement is well within the power of each and every hospital; that such programs are consistent with sound financial planning, whether under a fee-for-service, bundled, or capitated payment arrangement; but that progress on this front demands leadership from the administrative and clinical leadership; and that such leadership must include a commitment to redesign the hospital's workflows using Lean principles or other approaches that engage front-line staff and also engage patients and family members in a respectful and meaningful way.
A more conversant observer than I, Harold D. Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, offered some useful thoughts on these matters in a talk he recently gave in Oregon, entitled "Reducing Readmissions: How Oregon can become a national leader in reducing costs and improving quality." I will present just a few slides from what is a very thorough presentation.
First he summarized the multi-factorial nature of the problem.
Next he gave a summary of the kind of work that is currently being carried out. He included lots of examples that I do not have space for here.
Then he pointed out that a big percentage of the readmissions are not caused by hospitals.
Nonetheless, he explained that hospitals could have a role in reducing the number of readmissions.
In the final slide in his presentation, he gave a work plan for those hospitals wishing to make a difference in this arena. I particularly like the last bullet.