I wasn’t at all surprised to have encountered two separate articles a few weeks back highlighting studies that demonstrate the disparity between quality care and the incidence of patient readmission.
A FierceHealthcare article notes that “Quality care guidelines and public reporting of performance scores through Hospital Compare won’t keep patients from readmitting.” The article cites a study from the Journal of General Internal Medicine, which shows that “hospitals with greater adherence to recommended care processes did not see significantly lower 30-day readmission rates.” It was less than one percent as a matter of fact.
Another article from Foxnews.com/health stated: “Procedural guidelines designed to ensure patients get quality care while in the hospital are also thought to reduce the chances a patient will need to be readmitted down the line, but a new study suggests there’s little connection between the two.”
Both articles point out precipitating factors that are beyond control of hospitals, such as social factors, income level, employment status, race, education and age, compliance with medications, smoking cessation and follow-up visits with primary care physicians. This leaves me with two questions: First, will CMS re-evaluate the 30 day readmission penalty for hospitals that can demonstrate evidence-based, high quality care? And what might be the more interesting question since health insurance is mandatory for the individual: What part of the risk should be shared by the patient for quality self care in order to prevent readmission? I see this as the inevitable end game.
It all comes down to taking better care of ourselves. Former journalist and Wall Street technology analyst Ester Dyson said it best; “There is a corollary to freedom and that’s personal responsibility, and the real challenge is how you generate that personal responsibility without imposing it.”