No one fix to slow hospital readmission epidemic

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In Fort Washington, Md., Reggie Stokes started asking questions after his 84-year-old stepmother was hospitalized four times in a row, for transfusions to treat a rare blood disorder. He found a specialist in another city who said a bigger dose of a common medication is all she needs.

The hospital “could have helped her and saved money” by doing that legwork, Stokes said. His advice: “You have got to go out and do research for yourself.”

That’s hard when you’re feeling ill, said Lincoln Carter, 50, of New York, who didn’t think his pneumonia was under control when the hospital discharged him.

But, Carter said, “I didn’t even really know the questions to ask.” Nor could he get to his regular doctor’s office. When “you can’t breathe, the last thing you want to do is sit on the subway.” A few days later, he was back in the hospital.

Patients don’t have to be powerless, and the Robert Wood Johnson Foundation this week begins an effort called “Care About Your Care,” which offers consumers tips to guard against unnecessary readmissions.

“Everyone has to understand their role in improving the quality of care, including families,” said Dr. Risa Lavizzo-Mourey, the foundation’s president. “This could be a time when we turn the corner.”

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Rehospitalizations are miserable for patients, and a huge cost _ more than $17 billion a year in avoidable Medicare bills alone _ for a nation struggling with the price of health care.

Make no mistake, not all readmissions are preventable. But many are, if patients are given the right information and outpatient support.

The new Dartmouth Atlas evaluated Medicare records for 2008 to 2010, the latest publicly available data, to check progress just before Medicare cracked down. In October, the government began fining more than 2,000 hospitals where too many patients with heart failure, pneumonia or a heart attack had to be readmitted in recent years.

“Change is hard and comes slowly,” said Dartmouth’s Dr. David Goodman, who led the work.

Of seniors hospitalized for nonsurgical reasons, 15.9 percent were readmitted within a month in 2010, barely budging from 16.2 percent in 2008. Surgery readmissions aren’t quite as frequent _ 12.4 percent in 2010, compared with 12.7 percent in 2008. That’s probably because the surgeon tends to provide some follow-up care.

Medicare’s Blum told the AP that the government is closely tracking more recent, unpublished claims data that show readmissions are starting to drop. He wouldn’t say by how much or whether that means fewer hospitals will face penalties next year when the maximum fines are scheduled to rise.

But by combining the penalties with other programs aimed at improving these transitions in care, “we have now changed the conversation,” Blum said. “Two years ago, the response was, `This is impossible.’ Now it’s, `OK, let’s figure out what works.’”

Hence interest in the geographic variation.

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