More post-discharge options means fewer hospital readmissions

Health systems with more doctors and palliative services saw fewer patients bounce back to the hospital, a recent study found.

Health systems are under pressure to avoid hospital readmissions, and offering more post-discharge options can help prevent patients from coming back to the hospital.

Researchers examined more than 3,000 hospitals between 2013 and 2019 to determine factors that could affect readmissions. The study was published July 5 in Health Affairs.

Since hospitals can face financial penalties from Medicare, they have plenty of incentive to reduce readmissions, as well as fulfilling their primary mission of healing.

Overall, hospitals and health systems are going to have a better chance of avoiding readmissions if they offer patients more post-discharge options.

“Our results suggest that hospitals may take a more active role in the development of postdischarge care options in their communities or partner with existing infrastructure to improve continuity of care and clinical outcomes and to avoid penalties,” the authors wrote.

Here are some key takeaways from the study.

Areas with fewer return trips

Hospitals in areas with more primary care physicians saw lower 30-day readmission rates, the study found. Areas with a higher portion of licensed nursing home beds also experienced fewer 30-day readmissions.

Areas with more readmissions

Communities with a greater concentration of home health agencies and nurse practitioners had higher rates of 30-day readmissions, according to the study.

Home health agencies often have high turnover, which could be affecting the continuity of care. The higher number of nurse practitioners may reflect a lack of healthcare resources or an area with sicker patients. Nurse practitioners have succeeded in reducing readmissions in some areas, the authors noted.

Consider palliative care

Palliative care services reduced readmissions in some cases, but not all, the researchers found. Still, authors suggested health systems should look to develop more post-discharge services, including palliative care. “Palliative care use may reduce unwanted, potentially unnecessary medical care for seriously ill people,” the authors wrote.

“Palliative care use may reduce unwanted, potentially unnecessary medical care for seriously ill people, whereas patients in areas without sufficient access to primary care or nursing facilities (for example, isolated rural or low-income urban areas) may be forced to return to hospital emergency departments if complications arise,” the researchers wrote.

The value of partnerships

Health systems should look to offer more post-discharge options, but they don’t need to go it alone. “Hospitals may benefit from work to improve local access to care or hospital-community partnerships to improve continuity of care after discharge,” the authors wrote.

Reconsidering penalties

The Centers for Medicare and Medicaid Services should consider adjusting its formula to determine if hospitals should be penalized for readmissions, the authors wrote. CMS should look more closely at the characteristics of the community in affecting readmissions. The agency also shouldn’t include post-discharge supply measures, such as palliative care, in its analysis.

“Risk adjustment would dissuade hospitals from initiating a palliative care service and punish hospitals that already have one by decreasing their expected readmission rate and increasing their likelihood of receiving a penalty,” the authors wrote.

Study readmissions

If hospitals aren’t already doing so, they should look at readmission trends at different discharge sites. Health systems could find ways to improve care and reduce readmissions.