A recent headline claims that Medicare will penalize 2,211 hospitals for readmissions. Altogether, this equates to about $280 million in Medicare payments withheld while the government starts holding hospitals accountable for the number of patients who return within a month of discharge with complications related to the original diagnosis.
The article goes on to show teaching hospitals, hospitals serving the underserved, hospitals treating low-income families, and quite a few top-ranked hospitals will get the maximum penalties from Medicare. What the article fails to mention is the root cause of these readmissions. As the Practice Manager for Health BI, my first reaction is a strong desire to know the underlying cause of the readmissions. Today I can only speculate, so let’s do that.
Are these hospitals getting penalized for their healthcare or is the penalty for their lack of educating and informing their patients? I believe a huge part of the healthcare problem today is the industry has, for years, taught the patients to blindly follow the physician’s instructions. Now, these same patients are expected to understand their disease and treatment, follow a drastic lifestyle change in many cases, and continuously monitor their own health and make adjustments based on daily weight, blood sugar, blood pressure, and other vital statistics.
Patients are ill equipped to do this. Lower income and chronic patients are especially ill equipped for to manage their own health. Their lifelong habits that brought them here will not be reversed from a single 20 minute “training session” near the end of their hospital visit. It seems unfair to penalize the hospital for the patient’s failure to change.
How about some analysis to see if there are only one or two physicians or departments with high readmission rates? With business intelligence, we can crunch the numbers to see if a small percentage of the hospital operations are causing the Medicare penalties. It is far simpler to make minor targeted adjustments than to make sweeping overhauls of hospital workflows, especially when overhauls are not the answer.
Is there a patient age, race, lifestyle, or income level that accounts for the lion’s share of readmissions? BI tools could help pinpoint these causes and enable hospitals to target specific demographics that are the reason for their penalties. It might prove more cost effective to dispense medications to the underserved on a weekly basis from the hospital rather than hoping the patients will purchase those same medications from the pharmacy.
Are readmissions caused by the hospital or the patient? BI can help figure this out. For years, we have treated the problem, while potentially ignoring the symptom. From the hospital’s perspective, readmissions generate more income. Now Medicare is threatening to penalize the hospital for readmissions. What will this ultimately mean? Will the hospital turn away readmit patients just to improve their numbers? Will they alter their readmit diagnosis to prevent penalties? Will patient’s health decline as a result of stronger enforcement from Medicare?
What do you think is the real cause of readmissions? What are you doing about it?
Join my webinar, “An Introduction to Business Intelligence for Healthcare” on August 30th to learn more about the role of Business Intelligence in healthcare. Download our new whitepaper, “Business Intelligence Primer for Healthcare Professionals” to learn more about this topic.
