The federal government's policy to penalize hospitals for higher-than-expected rehospitalization rates, beginning on October 1, 2012, has been widely debated. Many argue that the penalties are falling too heavily on hospitals when poor care transitions and avoidable rehospitalizations are a result of community-wide problems. Others have protested that safety-net hospitals will be unfairly penalized since access to medical and social services for high-risk patients is limited. In my opinion, systems of “carrots and sticks” are at best imperfect and will most likely have unintended consequences.
Despite these concerns, I believe that the Centers for Medicare & Medicaid Services should be commended for taking action on an issue that until very recently received little attention despite the magnitude of the problem. Financial consequences do indeed raise awareness and focus attention. Today, readmission rates are increasingly grabbing headlines and are mobilizing clinicians in varied settings to take action – and this, alone, is progress.
But arguments over the methodology for measuring rehospitalization rates and assessing penalties, important as they are, risk losing sight of the broader purpose: the well-being of individuals entrusted to our care. Take a moment to think about health care experiences within your own circle of family and friends. I'd imagine that it won’t take you long to remember an instance, perhaps many, when a poor transition, lack of care coordination, or insufficient support resulted in confusion, uncertainty, and perhaps a bad outcome for one of your loved ones. While it is imperative that we find ways to successfully reduce health care costs, let’s not lose sight of our “North Star” – the experience of patients!
Rehospitalizations have long been an intractable problem and are often a result of multiple clinical and social factors, but a number of efforts have shown great promise. At IHI, we have fashioned an effort called State Action on Avoidable Rehospitalizations, or STAAR, which is funded by The Commonwealth Fund. The IHI STAAR team has been working with 150 hospitals and more than 500 community-based organizations in Massachusetts, Michigan, and Washington to improve the transition out of the hospital and into the next care setting.
So, what does IHI recommend to get started on the journey?
First, establish a cross-continuum team. Cross-continuum teams, a hallmark of the STAAR initiative, promote a shift in focus from site-specific care to the patient’s experience over time. Understanding interdependencies between care settings, hospital-based teams co-design care processes with community-based clinicians and staff, collaborating to improve the patient’s transition out of the hospital and into community settings of care.
Second, interview five patients who have recently been readmitted to the hospital. While it’s important for improvement teams to review data regarding readmissions, hearing first-hand from patients and family caregivers about the challenges they face after discharge is a powerful way to “engage the hearts and minds” of clinicians and staff to create a health care system that serves patients better.
Reducing readmissions isn’t just a hospital problem – it’s a health care problem, and solving it requires reaching beyond the hospital door. What’s needed is a shift from a focus on providing excellent care within the hospital walls to understanding and attending to the experiences and needs of patients over time and across settings. On this blog, I’ll be detailing practical tips, challenges, and progress about doing just that.
The improvement journey is long, but the opportunity is vast – yes, for lower costs and better value, but more importantly, for dramatically improved care for patients.