What to do about "Frequent Fliers," Patients Readmitted to the Hospital Shortly After Disc

The Washington Post newspaper recently reported in-depth on the problem of "frequent fliers," patients who leave the hospital, only to boomerang back days or weeks later. The newspaper states that they have become a front-burner challenge not only for hospitals and doctors but also for those trying to rein in rising costs.

Typically elderly and suffering from the chronic diseases that account for 75 percent of health-care spending, their experiences of being readmitted time and again reflect many of the deficiencies in a fragmented, poorly coordinated health system geared toward acute care, the Post reported.

There are many reasons for readmissions, including high rates of medical errors and hospital-acquired infections; lack of communication between doctors who care for patients in the hospital and their regular physicians; trouble getting a prompt doctor's appointment after discharge; missed referrals for home health care; and poor coordination and medication management during transitions from hospital to home or nursing home.

"Transitions are just so dangerous. Every time you move a patient from one setting or facility to another, you have to ask, 'Is something going to go wrong?' " said a geriatrician at Brown University Medical School, who has often treated her patients in nursing homes for conditions that otherwise would propel them back to the hospital. Teno said the ways nursing homes are paid mean it's often easier for them to let the hospitals take care of sick patients.

Experts don't agree on how many readmissions are avoidable. Dozens of promising initiatives designed to cut down on them are underway. But many experts say sweeping changes are needed in how health care is delivered and how hospitals and doctors are paid -- sensitive issues that confront Congress and the medical industry in the debate on overhauling the health system.

Readmission costs are staggering. One of five Medicare hospital patients returns to the hospital within 30 days -- at a cost to Medicare of $12 billion to $15 billion a year -- and by 90 days the rate rises to one of three. Within a year, two out of three are back in the hospital -- or dead. For more, read the story.

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Robert W. Carter, Jr. is a Virginia attorney whose law practice is dedicated to protecting the rights of the victims of nursing home and assisted living neglect and abuse in Richmond, Roanoke, Norfolk, Lynchburg, Danville, Charlottesville, and across Virginia. 

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