Pricey Problems


Hospitalists working to reduce readmissions and medication errors would do well to consider a new policy report that suggests the two systemic problems cost the healthcare system $46 billion a year.

The white paper sets out to identify specific actions—such as creating detailed discharge plans, having pharmacists make follow-up calls after discharge, and using bar-code technology to verify drug dosages—that public and private decision-makers can use to help tackle the issues. While the bureaucratic checklist devised by the New England Healthcare Institute (NEHI) and the National Priorities Partnership is a good broad brush, the report's value may lie in how it prods physicians to change the way care is delivered.

"It's a quick and easy guide, but what's beneath it is quite complex," says Karen Nelson, a former nurse and senior vice president for clinical affairs for the Massachusetts Hospital Association. "We've seen terrific pockets of expertise … but the real work has to come for all providers and programs to do this at the same time."

Nelson believes hospitalists are "clearly essential team leaders" in fighting both medication errors and readmissions. Medication reconciliation is a problem in each of those silos that HM groups battle daily. To wit, the Agency for Healthcare Research and Quality (AHRQ) has awarded SHM a $1.5 million grant for a three-year, multicenter medication reconciliation QI study. “As care-transition managers, hospitalists are well-positioned to analyze the pitfalls of care coordination and develop and implement quality-improvement solutions to improve patient safety," says Joseph Miller, SHM's senior vice president and chief solutions officer.

Nelson says NEHI's "compact action briefs" suggest that payment bundling is one answer to wasteful spending. However, while hospitalists agree the payment system needs work, they caution against the potential consequences of such a drastic shift.

"It really makes the case to move away from the fee-for-service model," Nelson says. "What we need to do is redesign the system to cover the patient regardless of encounter or what the driver is."

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