By REBECCA SEIDLER
With the growing population of boomers, and the increased hospital readmission rates, Medicare is on a rampage to reduce those 30-day patient readmissions. Medicare has developed the Hospital Readmission Reduction Program (HRRP). This program penalizes the hospital and reduces payments from Medicare if the hospital is listed as an "affected hospital." No one is safe. Yes, the main focus is on our hospitals, but it takes physicians, home health care, therapy, HHA etc. to keep our patients home and reduce readmissions. As the old saying goes, "It takes a City," and everyone plays a part in keeping our patients home and healthy after a hospital stay.
Physicians are on the front line. Hospitals are putting measures in place to help reduce those Medicare readmissions. These include, reducing medical complications during the hospital stay, clarifying discharge instructions to patients and care givers, and most importantly, coordinating with post-acute care providers. Hospitals are looking to the physicians to help them reduce the readmission rates. Once the patient leaves the hospital, the patient's care falls on the physicians.
So how can our physicians help keep their Medicare patients home, healthy and safe?
Provide interpreters for patients with limited English proficiency.
The hospitals and physicians must work together and provide communication to the patients to make sure they schedule a follow up visit within 7 days of discharge.
Make sure patients have a strong home healthcare program including nursing, social workers, physical, occupational and speech therapy.
The physicians and hospitals both have to play a part in making sure their patients have a smooth transition when discharged, and are being discharged to a safe home.
When patients come home they are usually weak from lying in a hospital bed. It is more difficult for patients to be mobile throughout their home after a hospital stay. Steps in the home can be challenging, if not impossible for a discharged patient to manipulate. If a patient comes home in a wheelchair, the physicians and hospitals should be concerned about making sure the patient can be mobile throughout their home. Are the doorways wide enough? Is there enough space in each room for the patient to turn the wheelchair? Are there ramps by the front door or garage for easy access into the home? Is the patient able to safely transfer into their shower? Are there cabinets under sinks to prevent a wheelchair bound person from reaching the sink faucet? If someone comes home with limited ROM (range of motion) of their upper extremities or lower extremities, from a total hip, total shoulder or total knee replacement, how can they reach items in high cabinets, or clothing on closet rods without falling? If someone comes home with COPD, is their home set up to help them conserve energy and reduce dyspnea, therefore reducing fall risks and reducing hospital readmissions? They may need hand rails in their hallways, grab bars in their bathroom or kitchen area. They may need a lift chair to help them stand. Discharging patients to a safe and accessible home is imperative to reducing hospital readmission rates.
Most times the home environment is overlooked by everyone, including the hospitals, physicians etc., and preventable falls will occur post a hospital discharge. If measures were put in place to check the home and/or have the caregivers fill out a home safety checklist that could be reviewed by qualified personnel in home safety, this would greatly reduce falls, and reduce hospital readmissions.
Physicians who oversee the patient's transitional/home care can request a home safety report from the home healthcare nurses and/or occupational/physical therapists. This is a discussion that is necessary amongst hospitals, doctors and home health care agencies to implement home safety into the HRRP.
Why is it important for Hospitals and Physicians to be Concerned with Safe Homes for Their Patients? The number one reason is to reduce falls post a hospital discharge. Falls in the home are too common when a patient comes home from a hospital stay, especially a long stay. These fall risks need to be reduced in the home. Patients require time to heal. They need rest, maybe medication, and a stress-free environment to come home to. This is one of the crucial factors to reducing hospital readmission rates.
Making that transition from a hospital stay to home requires many occurrences, and many medical and non-medical disciplines to help our Medicare patients reduce falls, stay healthy in their homes and most importantly, reduce hospital readmission rates.