Guest post by Dr Pradip Patel, M.D.
Professor and Associate Vice Chair for pediatric medical education at the University of Louisville School of Medicine
Red e App Business Advisor

As a health care provider, decreasing health care expenditures is a priority, and a point of focus for the team at Red e App as they begin to approach the healthcare technology marketplace. If one of my patients gets admitted to the hospital, the last thing they want is to return after discharge soon thereafter.

One in five elderly patients is readmitted to the hospital 30 days after leaving. That is 2.3 million rehospitalizations a year that rack up more than $17 billion in annual Medicare costs, according to an April 2, 2009 study in The New England Journal of Medicine by lead author Stephen F. Jencks, MD, MPH1. There is no consensus on how many readmissions could be prevented; however, several studies report up to 40% of these admissions could be avoidable.

Up to now, there hasn’t been a case for hospital administrators interested in taking up the challenging issue of readmissions. Recently, Congress gave Centers for Medicare and Medicaid Services (CMS) the power under the Patient Protection and Affordable Care Act to cut hospitals’ pay by up to 1% if they exceed a to-be-determined estimated 30-day readmission rate for patients with heart failure, heart attack or pneumonia, starting Oct. 1, 2012.

Hospitals are beginning to proceed with interventions to reduce readmission rates. Most strategies for reducing readmissions come under two broad objectives: Make sure patients understand how to care for themselves when they leave the hospital, and make sure they get the follow-up medical attention they need to keep their conditions under control. Improving discharge planning is essential to decreasing readmissions.

This must begin at the time of the sentinel admission. The teach-back method should be used for every instruction delivered to each patient. The teach-back method is a way of assessing whether a patient understands information.  For example the physician can ask: “I want to be sure I explained everything clearly. Can you please explain it back to me so I can be sure I did?”

Refilling prescriptions and scheduling a primary care appointment prior to discharge is also critical. Not only must patient’s prescriptions be refilled, completing a systematic medicine reconciliation process for all patients at each transition point within and from secondary care. Medicine reconciliation is an evidence-based process, which has been demonstrated to significantly reduce medication errors that occur at transition points of care (admission, transfer and discharge).

The term ‘patient discharge’ does not fully encapsulate the process that occurs when a patient leaves the inpatient setting. The ‘transition of care’ more appropriately describes the process.  This implies that medical care doesn’t cease, but transitions to another provider (primary care provider, nursing home, patient’s family and even an inanimate device to provide critical reference content as a persistent reminder of treatment and management). It also implies ownership of care to the patient themselves.

How can this transition of care be better facilitated in the current technological world that we live in? 

Increasing the efficiency of what we do on a daily basis has improved with the use of technology. However, as the founder of Red e App, Jonathan Erwin has stated: “With most, not all, but most business communication methods, such as; direct mail delivered to my street mailbox, email to my ‘inbox,’ phone calls to my home or mobile device and now text messaging – they simply lack the consumers participation, priority, and consent.” My 71-year-old mother in law routinely texts me. Smartphones are ubiquitous in all age groups.

Through Red e App, healthcare delivery systems (hospitals and other chronic care facilities) can send critical messaging that can enhance the outcomes, thereby decreasing readmission rates, at the same time maintaining patient privacy.  Red e App can be utilized to send patients notifications including the following: your Coumadin dose was recently changed to X mgs twice daily; your prescriptions were refilled and will be shipped via Express Scripts; your follow up visit to your internist is on February 2nd at 8am; prior to your follow up to the cardiologist on February 14th, please have a repeat chest x-ray completed.

If we are to reduce health care costs, decrease readmission rates, and provide quality health care to our patients; we must utilize technology in an innovative manner to enhance communications with the health care team, including our patients.

Dr Pradip Patel, M.D.

 

1.    Stephen F. Jencks, M.D., Mark V. Williams, M.D., and Eric A. Coleman, M.D., M.P.H., “Rehospitalizations Among Patients in the Medicare Fee-for-Service Program,” New England Journal of Medicine, vol. 360 (April 2, 2009), pp.1418-1428.