Caregivers Reduce Readmissions When Patients Fear Hospital Discharge

• Published in: Journal of Health Care Compliance Vol. 22; no. 3; pp. 61 - 65
• Main Authors: Novak, Leasa, Moffett, Maurice L
• Format: Trade Publication Article
• Language: English
• Published: Frederick Aspen Publishers, Inc 01.05.2020
• Subjects: Appeals; Beneficiaries; Caregivers; Discharge planning; Health care policy; Hospitalization; Hospitals; Medicare; Patients; Quality improvement; United States > US; California
• ISSN: 1520-8303

[...]California Senate Bill No. 675 requires hospitals to (1) allow patients to identify a family caregiver; (2) notify that caregiver before the patient is discharged; and (3) provide instruction to the caregiver regarding post-discharge care needs of the patient.1 Currently enacted in more than 40 states, the foundation of the state-based CARE Act is a requirement for health care providers to include the patient's designated caregiver in the discharge planning process. [...]the University of Pittsburgh Health Policy Institute found that for elderly patients, systematically incorporating informal caregivers into the process of discharge planning could reduce 90-day readmissions by up to 25 percent and reduce 180-day readmissions by 24 percent.2 Thus, the voice and the perspective of the care partner regarding the patient's care needs can be informative for discharge planners, case managers, social workers, and others involved in the transition of care. 30-Day Readmissions_ Potentially avoidable readmissions have been linked to higher health care costs for payers and worse health outcomes for patients.3 In recent years, a significant amount of research has addressed readmissions, particularly with the advent of value-based purchasing for hospitals. Medicare beneficiaries have consistently been the most likely to experience a 30-day readmission when compared to other patient groups; in fact, the 30-day all-cause readmission rate in 2016 was almost twice as high among those with Medicare compared to patients with private insurance.4 Current data on Medicare's Hospital Compare Web site for the 30-day hospital-wide all-cause unplanned readmission (HWR) measure shows that Medicare patients experience a 30-day unplanned readmission at a rate of 15.3 percent.5 Historically, 30-day readmission rates for Medicare patients have been as high as nearly 20 percent.6 According to the Agency for Healthcare Research and Quality (AHRQ), from 2010 to 2016, the readmission rate showed a relative decrease of seven percent for Medicare patients.7 Penalties imposed on hospitals in recent years and quality improvement interventions have likely contributed to the improving rates.8,9 Putting It All Together_ Livanta has found that caregiver involvement in the Medicare discharge appeal process reduces the probability of hospital readmission regardless of whether the BFCC-QIO appeal determination agrees or disagrees with the hospital's decision to discharge the patient. The rationale for the reduced readmissions is related to inclusion of family caregivers in the discharge planning process so that, even when patients believe they are unprepared for discharge, their family and other social support systems can help meet medical and daily living needs.