Readmissions: The Impact of Improper Handoffs From the Hospital
Hospitals have hundreds of departments, functions, regulatory requirements, and bodies of work that need to be done in order to serve their patients. Below is a table showing not even a complete listing of these things that a multi-facility hospital system of a major US metropolitan area would typically have:
As you can see, it’s not just a big list of medical specialties like oncology, nephrology, infection control, etc. There are a number of departments that even non-healthcare businesses would also likely have, such as Information Security and Facilities Operations. In short, a hospital is a Hydra with 1000 heads trying to maximize and sometimes over-utilize its resources and particularly its staff.
Basically, a person is sick, goes to the hospital, undergoes treatment as a patient, and is released with a post-discharge note by the Care Coordination unit. Currently, not many hospitals are following up with the discharged patients or doing the Transitional Care service. We realized that the quality of transitional care is directly linked to patient readmissions.
Two Major Impacts of Readmission for a Hospital System
For readers who are not too familiar with the healthcare industry, it might not appear so bad for a hospital if they get “frequent flyers.” Having so-called “repeat customers” means more business for the hospital, and more business = more money, right? Therefore, the remainder of this article will explain why hospital readmissions are actually not a good thing and thus should be avoided.
Readmissions are a Waste of Money
A key thing one needs to understand about hospital readmissions is that the kind you want to avoid are unplanned readmissions. Sometimes the patient actually does require subsequent admissions to the hospital as part of the course of treatment that their care team determined to be the most effective. This kind of readmission is perfectly fine and to put it bluntly, a great revenue generator for a hospital, as these protocols would often include expensive but medically necessary procedures that can’t feasibly be provided in a home or even outpatient setting.
Unplanned readmissions are actually extremely costly for a healthcare system. Hospital readmissions cost Medicare about $26 billion annually, with about $17 billion spent on avoidable hospital trips after discharge. They use up human and physical resources that take away from patients who have acute, emergent, genetic, or otherwise unavoidable conditions for whom medical staff and hospital beds should be available at all times, at a moment’s notice. The more that hospitals reduce their unplanned readmissions, the better and sooner they will be able to care for these complex patients, resulting in a huge increase in quality of care and positive patient outcomes.
Readmissions are Bad PR
If a hospital mishandles the discharge of a patient in order to get them out of the hospital sooner and free up a bed for the next patient, this can and most definitely has caused negative press that has real repercussions in terms of the hospital’s public image. Several years ago one of the largest HMOs in the country completely botched the discharges of a certain patient population in the Los Angeles metro area. Long story short, homeless patients were unceremoniously dumped onto Skid Row, still wearing their branded hospital gowns. It was a marketing department nightmare for the HMO that took several years of damage control and shiny television commercials to recover from.
Of course that was an extreme example, but if a patient doesn’t have a good handoff from the hospital’s discharge department that ultimately results in an unplanned readmission, you can bet that the patient’s family will let others know about their poor experience — they will leave negative reviews on widely-read websites such as Yelp, or call the local media to have their story featured in on-air programming and online newsfeeds.
Hospitals have tried yet struggled badly at providing this service
Despite understanding the dire problem of readmission, hospitals realize that having a transitional care function would mean growing an additional head on the Hydra which must compete with the other 1000 for resources such as staffing and IT. This is an extra enormous strain on the hospital to operate at a high level without turnover or loss of adequate patient care.
Because the patient will no longer physically be under the care of clinical professionals on the hospital premises, then it’s critical to have an efficient and high quality follow-up service.
From Hydra to Hybrid
Startups such as ONclick Healthcare have been focusing solely on one service — Transitional Care to lighten the burden of hospitals already operating at or near 100% capacity resource-wise. Such a hybrid relationship, where Transitional Care is performed by a company like ONclick Healthcare, will provide patients much-needed continuity and dedicated follow-up care. This will translate into a reduction of readmissions.
In this article, we discussed the impact of readmissions from a hospital’s POV and the advantages of partnering with a Transitional Care provider such as ONclick Healthcare.
Please watch this space for Part Two of this series, in which we’ll explore the consequences of readmissions and the benefits of a transitional service from a patient angle.
