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Editor's Note |

Preventable Readmission—Is It in the Eye of the Beholder?

Mitchell H. Katz, MD
JAMA Intern Med. 2014;174(11):1872-1873. doi:10.1001/jamainternmed.2014.3105.
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Despite the emphasis on delivering patient-centered medicine, patients are rarely asked directly what they want or think. That is why I liked this study by Howard-Anderson et al.1 In the context of major national policy initiatives and hospital quality initiatives focused on preventing readmission, the authors asked patients who were readmitted whether the admission, in their view, was preventable. Only 27% said yes. To make the case for objective determination of preventable readmissions even more challenging, physicians agreed with the judgment of patients as to whether the admission was preventable in fewer cases than you would expect by chance.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Penalizing re-admissions is bad for patients
Posted on September 30, 2014
David Louis Keller, MD, FACP
None
Conflict of Interest: None Declared
Hospitalists are under a lot of pressure to discharge patients quickly; average length of stay by diagnosis is used as a performance metric by some employers. The hospital loses financially if the patient is kept in-house too long, under current payment schemes. This has led to the \"quicker and sicker\" discharge, and an unavoidable increase in \"bounce-back\" readmissions. Having spent the last decade as an outpatient-only internist, I have noticed that patients reporting for post-discharge check-ups look less well-healed than in the past. A number of times, I have been forced to send patients back to the hospital ER for re-admission. Practicing in a city which had 2 hospitals, I noted that if I sent the too-sick-for-home-care patient back to the hospital from which they had been discharged too-sick-and-too-quick, getting them readmitted was like pulling impacted wisdom teeth. If I sent the patient to the other hospital, though, they usually had no problem getting admitted. Medicare's readmission penalty is levied only against the hospital where the patient was originally treated and discharged too soon, which provides the financial motive to explain this phenomenon. Every penalty and financial disincentive imposed by Medicare and health plans is efficiently transmitted to employed physicians by their managers these days, and can lead to unforeseen and injurious consequences to patients. It is fortunate that I was able to circumvent this system for my patients for a time, but as hospitals integrate medical groups into their systems, such escape routes from the power of the payers will be blocked off.
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