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Why do readmissions continue to plague hospitals?
There’s one primary reason: It’s very difficult to control patients’ behavior once they are discharged. For example, hospitals cannot control whether patients take medications as prescribed, follow-up with providers and comply with other discharge instructions. This is a huge challenge for hospitals trying to reduce readmissions for conditions listed in the Hospital Readmissions Reduction Program (HRRP) of 2012:1 Chronic lung disease, coronary artery bypass graft, heart attacks, heart failure, hip and knee replacements and pneumonia. These are high-volume, high-cost readmissions, which is why CMS continues to target them.
Social determinants of health (SDOH)—the conditions in which people are born, grow, live, work and age—influence how likely it is that a patient will follow their discharge recommendations. Unfortunately, hospitals sometimes overlook these factors because they rely entirely on clinical data that only tells part of the story. This means they may not ever address the root cause of the readmission. Thus, the cycle continues.