Inside Medicine: Cutting back on readmissions
12/06/2012 12:00 AM
12/05/2012 3:14 PM
Leon was admitted this year to the hospital with heart failure six times. Each time, after a few days, he felt intense pressure from the doctors to go home – well before he felt strong enough to manage on his own.
He lived alone on the third floor of a small apartment house and getting upstairs to his apartment took 20 minutes and many periods of rest.
His regular doctor prescribed eight medicines, which he took several times a day. Each time he was sent home from the hospital he came home to his usual eight medicines, plus the doctors in the hospital always sent him home with new bag of about six new medicines. His kitchen table looked like a pharmacy.
Leon is not unique. A study from the Journal of General Internal Medicine showed that 81 percent of older patients discharged from a major teaching hospital had problems with medications – they didn't understand how to take their drugs, they were taken off a drug they needed, they were prescribed the wrong drug or wrong dose, or they just never picked up their new prescription at the pharmacy.
For Leon, the large pile of medicines on the kitchen table was overwhelming. He wasn't sure which of the drugs he should be taking and which he should not. He knew some drugs did the same thing, but wasn't sure which ones. He feels that at least a couple of times this past year he ended up in the hospital because he didn't take the right medicines.
While Leon reports doctors did a good job of caring for him in the hospital, he said their job seemed to end the moment his cab drove out of the parking lot. His own family doctor was never told what happened to Leon in the hospital, or what medicines he was sent home on.
But Leon may be surprised to find that all this has changed the next time he leaves the hospital. Last month the federal government announced new penalties on hospitals with too many readmissions. Hospital care is by far the largest part of Medicare spending, and Medicare readmissions cost $30 billion over the past decade. Now hospitals will need to help keep people on the road to recovery once they are sent home.
Hospitals will need to set up follow-up appointments with doctors, give careful instructions about how to use medications, provide recipes for special diets that can be lifesaving and even provide follow-up nursing care at home.
While all these steps make perfect sense, and they may cost hospitals more money, such care is far less expensive than having to readmit a patient such as Leon to the hospital for free. After all, Leon's average hospital bills range from $30,000 to $50,000 per admission.
Hospitals are certainly moaning about the extra work and feel it is unfair. They feel they shouldn't be responsible for people who don't take their medicines or can't afford to buy medicine. But from this doctor's perspective, this policy is long, long overdue. Hospitals have refused to work as a system with community-based doctors, nursing homes and families to maintain health once a person leaves the hospital.
Also, hospitals, at least in our area, often are not-for-profit organizations, yet they regularly end up at the end of the year with large surpluses that could be spent to keep people healthy and out of hospitals rather than being spent on high-tech robots or other untested technology.
With the Affordable Care Act, we can expect to see enormous changes in the way health care is delivered over the next few years. If this policy is any indication of what we can expect, it will be very good news for the public.
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