Currently, Medicare and private insurers are attempting to put in place incentives to reduce the number of readmissions. Visits to the hospital are costly and reducing the frequency of hospital visits is the best means to reduce medical costs. In particular, if readmissions are the fault of the care the patients receive during the initial admissions, hospitals should be liable for subsequent care.
On the other hand, a recent letter to the New England Journal of Medicine, argues that high readmission rates may in fact indicate high quality care.
“A higher occurrence of readmissions after index admissions for heart failure was associated with lower risk-adjusted 30-day mortality. Our findings suggest that readmissions could be ‘adversely’ affected by a competing risk of death — a patient who dies during the index episode of care can never be readmitted. Hence, if a hospital has a lower mortality rate, then a greater proportion of its discharged patients are eligible for readmission. As such, to some extent, a higher readmission rate may be a consequence of successful care.”
My experience says that chronic disease readmissions may be a sign of a poor sick day plan or of poor patient adherence but more often represent the ebbs and flows of the chronic disease state and the limited number of venues of care (i.e. office, hospital and ?urgent care)
The better target is the newly ill who has now become a “patient”, is not prepared for the new meds, the needed follow up and the self care. In that circumstance, “retreating to the ER” is the easiest solution when symptoms recur and the office is closed (or no appointment till next week).