WIHI: Reality Knocks with Reducing (Hospital) Readmissions

Date: November 15, 2012


  • Patricia Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement; Co-Principal Investigator, STate Action on Avoidable Rehospitalizations (STAAR)
  • Elizabeth H. Bradley, PhD, Professor of Public Health (Health Policy and Management), Yale School of Public Health; Faculty Director, Yale Global Health Initiative
  • Leora Horwitz, MD, MHS, Assistant Professor, Internal Medicine, Yale University School of Medicine

Of all the improvement issues facing health care, reducing avoidable hospital readmissions may well be the one that finally breaks down traditional silos — and allows promising changes to realize their full impact. Why? In order to prevent patients from bouncing back into the hospital, front-line staff must create robust care coordination strategies across multiple health care settings, as well as the home and the community — taking a fundamentally broader view of the patient journey and the reforms needed.

However, doing the right thing ​— keeping patients out of the hospital — often hurts a hospital’s bottom line. So far, anyway. In the US, the Centers for Medicare & Medicaid Services (CMS) has now imposed fines on some 2,200 hospitals for higher-than-average readmission rates, as part of new federal policy. This latest move won’t make the financial piece any easier, but it does put hospitals on notice that there’s “nowhere to run, nowhere to hide.” If you want to reduce readmissions, you have no choice but to fundamentally redesign what you’re doing now.

What are the most promising ideas and strategies to look to and build upon? This WIHI convenes some important leaders and thinkers on reducing readmissions and care coordination that, between them, have a comprehensive view of what’s working, what’s challenging, and where we go from here. Elizabeth Bradley and Leora Horwitz are among the co-authors of an article in the Journal of the American College of Cardiology published in August 2012 that examines the all-too-persistent gap between best intentions and uneven execution of known best practices. Drs. Bradley and Horwitz discuss the study findings and what can be done to help health care organizations follow through on their own robust policies. In her role as Co-Principal Investigator of IHI’s STAAR initiative, Pat Rutherford has been deeply involved with hospital leaders and officials in three states that have taken to heart the challenge of reducing readmissions, with results to show for it. Pat Rutherford also carefully tracks the work of multiple initiatives in the US, including Project BOOST, Project RED, and Hospital to Home (also known as H2H).

WIHI host Madge Kaplan welcomes Dr. Bradley, Dr. Horwitz, and Pat Rutherford to the show, to share their crucial and timely insights and learning. These improvement leaders are keenly aware of the ways in which policy and reimbursement changes surrounding readmissions are giving hospitals that want to do the right thing a jolt.



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