FROM THE FOUNDATION

Redefining the Safety Net

Should California establish a Basic Health Program for certain low-income residents? CHCF's Marian Mulkey captures a recent policy conversation in a Health Affairs blog.

Accountable Care in Action

A new post on the Health Affairs blog details how CalPERS kept costs down in Sacramento through a "virtual" ACO with insurers and providers.

Career Opportunity: Senior Program Officer

This position will play a major role in furthering the goals and objectives of the foundation's Better Chronic Disease Care program.

Special Reports

Tuesday, June 15, 2010

Officials, Health Care Providers Working To Reduce Patient Readmissions in California

A recent report from the Office of Statewide Health Planning and Development found that more than one in three California hospital patients is readmitted within a year. 

In a California Healthline Special Report by Deirdre Kennedy, state and hospital officials discussed the best ways to respond to the OSHPD report.

The Special Report includes comments from:

  • Anne-Marie Audet, vice president for quality improvement and efficiency at the Commonwealth Fund;
  • Toby Douglas, deputy director of health care programs at California's Department of Health Care Services;
  • Patrick Johnston, president and CEO of the California Association of Health Plans;
  • Debby Rogers, vice president of quality and emergency services at the California Hospital Association; and
  • Mary Tran, OSHPD research scientist and lead author of the report.

OSHPD says the report is the first time the state has compiled and analyzed readmission figures.

Mary Tran, the report's lead author, said that although the OSHPD report does not examine the causes of hospital readmissions, it does point to areas where there is room for improvement in patient care (Kennedy, California Healthline, 6/14).

The complete transcript of this Special Report is available as a PDF.

Running Time: 4:59

Reader Comments:
  • 3
  • 07/12/2010
  • Katy Krul

According to tests conducted by the Centers for Medicare & Medicaid Services drop re-hospitalizations from 28% to 75% could be achieved if patients are discharged to Adult Day Health Care Centers where patients are monitored by RNs during half of the day, which allows for patient care during the hours that doctors’ offices are in operation. RNs at Adult Day Health Care Centers are able to contact primary care physician and follow up that same day, implementing doctor’s orders immediately, preventing many re-hospitalizations. I work for Oxnard Family Circle ADHC, we can serve up to 180 people a day, we have 6-8 nurses daily as well as PT, OT, Dietitian, 6-8 social workers. We transport to center & back to home including wheelchair bound patients, provide 2 hot dietary meals & all the personal care including feeding, toileting and showering. Services are covered by Medi-Cal for those who are low income; by VA for veterans, by Tri-Counties RC. The ADHC centers are gems & underutilized.

  • 2
  • 07/02/2010
  • Jacqueline Letourneau-Wagner

As a pharmacist, I've seen discharged patients & families struggling to manage their discharge medications. But I also see large numbers of low-income patients & parents of ill children coming from the hospital ER, which must provide basic care to indigents. They go there because there is no other place to go, and they go for minor injuries, urinary tract infections, coughs, colds and upper respiratory infections. Each time they go, it costs the hospital and/or the taxpayers a major amount of money and ties up the ER Staff; the patients do not have the money to pay. Many times, they do not go to the ER until they are desperate.

Reducing re-admissions is a laudable goal; meanwhile, establishing some type of centrally-located "free" or sliding scale clinics may be a good way to cut hospital costs, reduce wait time for people who actually have an emergency, and give low-income or indigent people an opportunity to obtain preventive care and to avoid the first hospital stay altogether.

  • 1
  • 06/16/2010
  • Robert Forster

Audet is too quick to condemn the system while Ms. Rogers says it all-"It is not clear..." It is true that poor aftercare from acute hospitalization increases the chance of an early re-admission. But now with hospitals seeing much more serious (high acuity) patients than previous decades, what exactly is the Quality Benchmark for 1 year readmission for people with severe chronic diseases? We don't know. Maybe 1 in 3 is appropriate care. Thus, a much more detailed, deeply look into this data for cause and effect is necessary before drawing condemning conclusions. We know we can always do better--but how much is the question and is important to programs based on extrapolated medical cost savings from lowering readmission rates of the chronically ill. Without a better understanding, these programs will be budget busters. Rob MD



Readers are invited to send feedback to: chl@chcf.org