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What One Chief Medical Officer is Thinking About Readmissions

This blog post excerpts an article in the Q3 2015 issue of PX Advisor, our quarterly magazine designed to bring you thought leadership and best practices for improving the patient experience.

Comments on Readmissions from Michael S. Oleksyk MD, FACP, CPE, CMPE; Vice President of Medical Affairs, Chief Medical Officer, Practicing Hospitalist; Baptist Health Care, Pensacola, FL

With so many priorities for 2015, how important is reducing readmissions? How much effort do you see focused in this area?

I think hospitals take this initiative very seriously. It is definitely on their radar screens because of the high financial penalties that are involved. We are aggressively looking at ALL 30-day readmissions, not just the five diagnoses targeted by CMS. We are routinely watching our rates as part of our on-going physician quality monitoring.

What is your opinion of the Hospital Readmission Reduction Program (HRRP)? 

I’ve been in practice for more than 30 years, and this is actually something that is overdue. We shouldn’t be rewarded for poor quality or unsafe care. But there are a lot of gray areas in the program too. For example, we shouldn’t be penalized for unavoidable readmissions or when the readmission is unrelated to the initial inpatient visit.

What are the key steps hospitals should take to reduce readmissions? What do you see working?

The key is to take multiple steps to prevent a readmission. We need to be focused on plans for discharge as soon as the patient is admitted. You can’t wait until the day before. You need to try to have everything in place before the patient leaves the hospital. There also needs to be good communication all around. Physicians, nurses, case managers, social workers, therapists, family members, and the patient all need to work together during the patient stay to address all of the patient’s post-discharge needs. We also need to be in contact with the pharmacy department to make sure they can support any unusual medications that the patient might need upon discharge. Finally, we try to ensure that there is prompt discharge follow-up with the primary care physician and other post-acute organizations that might be involved. We know there is a strong relationship with how soon the patient sees their primary care physician and readmission rates.

What impact is the HRRP having on hospitalists?

We have to be heavily involved in efforts to reduce readmissions. We can’t just sit back and let others work around us. Some 70% of our patients are followed by a hospitalist, with 15% - 20% of these being cardiology patients, so we are covering a lot of patients that may be at high risk of readmission. It doesn’t look good on our records when one of our patients is readmitted. It’s embarrassing and inherently wrong to have patients be readmitted because they couldn’t get the necessary medicine or the appropriate follow-up care. 

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