Thursday, November 15, 2012

Comment on: Hospital guidelines not linked to readmissions | Fox News

I thought this was interesting considering all the recent discussions of lowering costs of Medicare tied to the readmission rates.  The article: Hospital guidelines not linked to readmissions | Fox News discusses a study that finds that the readmission rates may not have as much to do with what the hospital does as was previously assumed, and I would agree.

Being someone who has dealt with both a child and a parent being in the hospital with something like Pneumonia, I can see the vast difference in the follow-up care between the two (assuming most individuals on Medicare are older adults).  When we brought home Bean from the hospital after having been in with pneumonia, we were told to go see the pediatrician within 48 hours.  We had a follow-up chest X-ray done to make sure the pneumonia was staying gone.  All this required driving from our home to the pede's office to the X-ray place and back home again.  We did another follow-up appointment about 48 hours after that as well.  As individuals who drive regularly, this was relatively easy for us (we also have flexible jobs thankfully).  But, for my mom, who doesn't drive anymore and has a husband with dementia and mobility problems, getting back to follow-up appointments requires that she finds someone who can not only take her to the appointment, but also find another person to "watch" my dad while she is gone or someone who is willing to take him along and sit in the car the entire time if he is having a low-mobility day.  That also means she has to go into the doctor alone.  None of this is easy for her.

I imagine she is not that unique in this respect.  And for individuals like my dad, he has to have someone who can help him with medicines and getting to a follow-up appointment is a true investment in time and effort.  My point here is that if, as the reference to the Reuters article says:
Another recent study suggested that many factors outside a hospital's control can cause a patient to need rehospitalization. For example, the person's ability to keep up with their medications at home, or to make follow-up visits to a personal physician (see Reuters Health article of October 19, 2012, here:
is correct about it being more a question of follow-up, Medicare could save a lot of money by figuring out a way to provide more services that allow for people like my mom and dad to get the follow-up care they need without it becoming a burden on them or others who are helping with care.  Sometimes, phone calls may work.  Other times, maybe in-home visits would be more economical and helpful.

I think that the health system has become a difficult to navigate and expensive, not just for the health care itself, but even to access that healthcare, undertaking because of bureaucratic and corporatist requirements placed on individuals working within that system.  Access to healthcare may mean less hospital visits in the first place and certainly less readmissions, which seems to be a concern.  In this age of technology, it seems that basic follow-up visits could easily be more mobile in nature.

Again, I focused on older individuals in this post because that is the majority of Medicare recipients.  But, I can see problems with younger people as well who lack flexibility in their jobs to take additional time off for follow-up appointments or who can't afford to get prescriptions filled right away after a hospital stay, etc.  The mobile follow-up for health care is obviously not the silver bullet of solutions, but it seems to me it may be one possible solution for this cost of readmission.

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