Groups try simple steps to avoid a hospital rebound

WASHINGTON — Talk about unnecessary misery: One in five Medicare patients winds up back in the hospital within a month — even worse, one in four patients with heart failure.

A major push is under way around the country to cut rehospitalizations, in part by arming patients with simple steps to keep their recovery on track — like getting past harried receptionists for quicker follow-up doctor visits, and reducing medication confusion.

Less than a year into a Medicare-sponsored “Care Transitions” project in 14 states, participating hospitals already are seeing readmissions start to inch down, says Dr. Barry Straube, chief medical officer of the Centers for Medicare & Medicaid Services.

One of those projects, in Baton Rouge, La., sends health coaches to five area hospitals to guide high-risk patients through discharge and check how they’re faring through that critical first month. Of the first 145 patients coached so far, only seven had to be rehospitalized.

The key: Support, so that weakened seniors don’t backslide merely because they couldn’t get a timely doctor’s appointment or had no ride to the drugstore to pick up a prescription, says coach DeeAnn Broussard with Louisiana Health Care Review, a quality-improvement company leading the project.

Rehospitalizations ought to be handled with the same urgency as an epidemic, says Dr. Harlan Krumholz of Yale University.

“Somehow this idea of one in four people landing back in the hospital in a month is treated as business as usual, that it’s part of being sick in America. It doesn’t have to be that way,” he says.

The top risks:

n Medication problems. Patients on a dozen or more drugs forget which ones they’re supposed to toss when given new ones in the hospital, or can’t afford the new ones, or have no way to pick them up.

n Not getting a follow-up doctor’s visit within a week of discharge. Waiting longer is proven to increase rehospitalization. Yet even if patients have a primary care doctor, getting a rapid appointment can be tough.

n Not realizing early signs of trouble and knowing what to do about them.

Rehospitalizations aren’t just bad for patients, but for taxpayers, too. They’re costing Medicare $17 billion a year, a recent study estimated. Hospitals make more money when patients have to return.