New Cost-Control Strategy


A recent study that associates lower 30-day readmission rates for heart failure patients who receive followups within one week might be a jumpstart to new incentives for fewer readmissions, says the report’s author.

“In a way, [hospitalists] are central to all this,” says Adrian F. Hernandez, MD, MHS, an assistant professor at Duke University School of Medicine and a cardiologist at Duke University Medical Center in Durham, N.C. “During the hospital stay, they are quarterbacking that patient’s care. They have a central responsibility to make sure that patient discharge is seamless.”

The study tracked 30,136 patients who were seen at 225 hospitals from January 2003 to December 2006. It reported that in the first 30 days after discharge, 6,428 patients (21.3 percent) were readmitted (JAMA. 2010;303(17):1716-1722).

At the hospital level, the median rate of early followup was 38.3 percent. According to the study, patients whose index admission was in a hospital in the lowest quartile of early followup had a 23.3% 30-day readmission rate. The rates of 30-day readmission were 20.5% among patients in the second quartile, 20.5% among patients in the third quartile, and 20.9% among patients in the fourth quartile.

Dr. Hernandez says the next step is for hospitals and their staffs to commit to more streamlined transitional-care techniques that include immediate followup with patients, be it via teleconferencing with doctors or phone calls with nonphysician providers (NPPs) or clinical pharmacists. He adds that incentivizing doctors to reduce readmissions is a logical next step to improving the discharge process.

“Now that 30-day readmissions are publicly reported and hospitals are being held accountable for that, they need to invest in systems that will enhance that transitional period,” Dr. Hernandez says.

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