15 June 2011


A combination of giving patients more information about their conditions and better managing their medications can slow the revolving door of Medicare patients in and out of hospitals by about 20%, a study released Monday shows.
Researchers determined that physicians often did not have a complete list of medications that other doctors had prescribed for a patient, so they prescribed drugs that reacted badly with the patient's other medications. Most often, patients did not understand the care they were receiving or needed.
This information can help hospitals better cope with part of the health care law that will force them to repay Medicare for the cost of patients who are readmitted to a hospital within 30 days of their previous stay, researchers said. Previous research showed that one in five Medicare patients returns to the hospital within 30 days of a previous admission.
It costs Medicare $17 billion a year to pay for patients who are readmitted to the hospital within 30 days of their last stay.
The change takes effect in October 2012, and includes re-admissions for heart failure, heart attacks and pneumonia within 30 days of a previous stay. More diseases will be added to the list.
It also turned out to be true that more people were sent home than to long-term care.
The researchers compared 862 patients who entered a rehabilitation center in Boston from June 2009 to May 2010. Patients enter skilled nursing facilities when they are not sick enough for a hospital nor well enough to go home.
Researchers asked patients with congestive heart failure if they would want more surgery that might extend their lives or if they preferred less-invasive treatments. Some chose to manage the symptoms instead of continuing more expensive treatments. Often, patients and physicians had not talked enough for the doctor to realize the patient did not understand his or her medical condition.
Doctors talked to patients who had been admitted more than three times within the previous six months about palliative care, or care that manages symptoms with the understanding that the patient would not recover. They also gave patients copies of all their medications so they could provide that information to future doctors.
The center changed policy so a nurse and pharmacist each checked prescriptions after a doctor saw a patient. They provided details of care so patients could serve as a safety check.

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