No one fix to slow hospital readmission epidemic

WASHINGTON (AP) - More than 1 million Americans wind up back in the hospital only weeks after they left for reasons that could have been prevented _ a revolving door that for years has seemed impossible to slow.

Now Medicare has begun punishing hospitals with hefty fines if they have too many readmissions, and a top official says signs of improvement are beginning to emerge.

“We’re at a very promising moment,” Medicare deputy administrator Jonathan Blum told The Associated Press.

Nearly 1 in 5 Medicare patients is hospitalized again within a month of going home, and many of those return trips could have been avoided. But readmissions can happen at any age, not just with the over-65 crowd who are counted most closely.

Where you live makes a difference, according to new research that shows how much room for improvement there really is. In parts of Utah, your chances of being rehospitalized are much lower than in areas of New York or New Jersey, says a report being released this week from the Dartmouth Atlas of Health Care.

The AP teamed with the Robert Wood Johnson Foundation to explore, through the eyes of patients, the myriad roadblocks to recovery that make it so difficult to trim unneeded readmissions.

The hurdles start as patients walk out the door.

“Scared to go home,” is what Eric Davis, 51, remembers most as he left a Washington hospital, newly diagnosed with a dangerous lung disease. His instructions: stop smoking. He didn’t know how to use his inhaler or if it was safe to exercise, until a second hospitalization weeks later.

There is no single solution. But what’s clear is that hospitals will have to reach well outside their own walls if they’re to make a dent in readmissions.

Otherwise a slew of at-home difficulties _ confusion about what pills to take, no ride to the drugstore to fill prescriptions, not being able to get a post-hospital check-up in time to spot complications _ will keep sending people back.

“This is a team sport,” says readmissions expert Dr. Eric Coleman of the University of Colorado in Denver. It requires “true community-wide engagement.”

Pushed by those Medicare penalties, hospitals are getting the message.

“It’s made hospitals go, `Oh my gosh, just because they’re outside my door doesn’t mean I’m done,’” said nurse practitioner Jayne Mitchell of Oregon Health & Science University, who heads a new program to reduce readmissions of patients with heart failure.

In a pilot test, her hospital is sending special telemedicine monitors home with certain high-risk patients so that nurses can make a quick daily check of how these patients are faring in that first critical month.

Too often, families don’t realize that many readmissions can be prevented.

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