Medicare is going to penalize hospitals that have high readmission rates.  Take it to the next step: hospitals are going to be held accountable for what happens once their patients are home.  The consequences of a revolving hospital door for Medicare patients who are re-admitted within 30 days of their discharge will soon be affecting the hospital’s bottom line.  What used to be considered more revenue, inpatient admissions, is going to cost hospitals money starting October 2012, when a Medicare patient is readmitted in less than 30 days.

Preventing rehospitalization is nothing new for home care agencies.  We’ve been held accountable for a while now.  Now the ‘re-hospitalization onus’ will be on them and us.   Hasn’t it always been in the healthcare landscape ‘them then us’, for that matter?? Maybe hospitals will see greater value in improving communication with their home care partners now that their bottom line will be impacted.  Hospital administrators are finding Medicare’s levy unfair because hospitals have no control over the patients’ home environment and community resources.  Hello???  Welcome to our world!!!!  Here’s an opportunity for home care to come to the rescue.  Making home care services a part of the rule not the exception in discharge planning would seem to be a logical step to address this problem.

I’ve been reading about how hospitals, especially teaching hospitals and large urban medical centers, are gearing up for this Medicare change. Examples of care transition ‘coaches’ visiting patients in the hospital, at home and on the phone makes me wonder why hospitals feel like they need to create another layer of care especially when home care has been there all along and does this quite well.  Another example: hospital nurses becoming more involved with assuring follow-up appointments for their patients before they are discharged.  I’ll bet hospital nurses have a lot to do already without adding the burden of after care.

Because we already know that problems with medications are at the head of the list of reasons for hospital readmission, efforts to employ evidence-based practices in medication management will continue to have a major impact on re-hospitalization rates helping ‘them and us’.  If you’re involved with the day-to-day care of patients, you may find a new tool we’ve added to the CHAMP Resource section helpful: “Improving Medication Adherence in Older Adults: What Can We Do?”  Problems with medication adherence can be very challenging.  This tool lists factors that contribute to non-adherence and strategies that can be used to use to address each one.  You’ll also find many other evidence-based tools in the Tools section of the CHAMP web site by selecting topics such as “Medication Management,” “Behavior Change and Adherence,” and “Rehospitalization” from the ‘All Topics’ drop-down menu.

Perhaps hospital and home care partnerships will become more widespread in an effort to assure that the inpatient remains an outpatient for as long as possible.

Medicare may force the hand of hospitals to look upon home care as the answer to stemming their re-hospitalization tide.  I hope so.

Debra Bertrand, CHAMP Facilitator