A Leap Of Faith
Discharges, Re-Admissions, and Post-Acute Care
I was chatting with the chief hospitalist at a major medical center yesterday and he reminded me of something I understood all-too-well. As a doctor, you can't keep a sick patient in the hospital forever. There can be a big difference between stabilized and stable enough that you're confident that the patient won't "bounce back" and be re-admitted. Discharging patients is often a leap of faith, faith that they'll continue to improve after hospital care.
There were lots of articles in yesterday's newspapers like this one:
And this one from USA Today and Baylor:
The CMS study of Medicare records showed Baylor University Medical Center in Dallas has the lowest readmission rate for heart failure in the country, at 15.9%. Baylor invested some $20 million in measuring and improving performance at all 15 of its hospitals. Part of the success comes from intensive follow-up after discharge to ensure patients are complying with treatment regimens. USA TODAY (07/09)
The national re-admission rate according to CMS is about 20% within a month of discharge, and readmission rates have been added to hospitalcompare.hhs.gov. Here is an example :
Hospitals, whether the physician involved is a hospitalist or a private physician, are driven to discharge patients who are stable, presuming that their post-discharge care is adequate. Organizations like Baylor, above, have stepped up to the challenge of effectively offering post-discharge care in various ways, away from the hospital.
Last month at the first annual X3summit, Johns Hopkins's CIO Stephanie Reel and her team detailed a variety of dramatic programs to deliver care outside of the hospital.
The implications for CIOs and other readers of these blogs is pretty obvious. The walls of the hospital are coming down. And that's a great thing!