There’s lot’s of discussion on the need to reduce hospital readmissions and Medicare is now penalizing hospitals that don’t do enough to actually reduce the number of patients that get readmitted. This is actually a big problem. The annual cost of Medicare admissions is $26 billion, $17 billion or 65% of that total is spent on readmissions.
Some hospitals don’t see how they can have an impact because their patient populations are sicker and have limited access to resources that can make a difference.
It seems reasonable that not all readmissions can be stopped or reduced (but we should try) and if a hospital were to focus only on the sickest patients they would probably have limited success in reducing many of those readmissions due to the chronic nature of the patient and their illness. So it makes sense to look at the balance of the patient population that may fall into one or more the of following categories:
- They did not know how to take care of themselves at discharge
- They ignored discharge advice
- They were not capable of understanding what to do
- They failed to consider how important the discharge instructions actually were
- They forgot the information they were given
- They were not provided enough details about what to do
- They were just told to follow up with their regular doctor in two weeks and never did
- Or, any number of other reasons.
No two patients are alike so there is no silver bullet or one size fits all approach. However, it makes sense that a few principles or goals, if set and followed, could lead to better results. Simple processes achieve better results than complex ones. Why? If they are simple they are easier to remember and follow.
In research conducted by Jochanan Benbassat, MC and Mark Taragin, MD, MPH they looked at Hospital Readmissions as a Measure of Quality of Health Care. One of their findings was “randomized prospective trials have shown that 12% to 75% of all readmissions can be prevented by patient education, predischarge assessment and proper* aftercare”.
So what does a 12% to 75% reduction in readmissions look like? Let’s make some assumptions to get a better picture:
- The average number of days per hospital stay in the U. S. is 4.9 days.
- The average cost per stay in the U. S. is $33,079.00.
- Our sample hospital has about 20,000 in-patient admissions annually.
- It is estimated that 14% of readmissions occur within 30 days and 49% within one year.
- For our sample hospital this represents 2,800 readmissions in 30 days and 9,800 readmissions in a year.
- A 12% reduction in annual readmissions is 1,176 patients and a 75% reduction is 7,350 patients.
- Factoring in the average cost per stay…
- The 1,176 reduction in readmissions represents a savings of $38,900,904.00.
- The 7,350 reduction in readmissions represents a savings of $243,130,650.00.
These numbers are staggering in their scope. But can we realistically expect to achieve savings like this? Probably not. But if a hospital only achieved a 10% reduction in the minimum bracket (12%) that represents over $3 million in potential savings and that’s a reasonable number that people can wrap their heads around.
Do you agree that simple processes are better than complex ones?
Do you think hospitals can reduce readmissions?
Would you like to see what the cost savings would be for your hospital?

* The study language was domiciliary care but I think we can assume “proper post-discharge care” because not all patients will need skilled nursing or other non-home healthcare resources. For those being discharged to their homes proper care can mean many things and I will explore this in an another post.
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