Hospital readmissions are all the rage. There is some good research being done and some thoughtful initiatives, as there often are in health care. But then there are always the reports that make you think they were composed by a committee of people whose employers wanted to keep them from doing anything harmful at the real work of the firm so they sent them to spend endless hours on a topic, only to end up with a report that adds absolutely nothing to the body of knowledge on the subject. The recent report from the Northeast Business Group on Health falls squarely into this category. (NBGH Report) The report refers to preventable hospital readmissions as a “crisis” that may cost as much as $25 billion a year. In the context of our health spending, $25 billion is hardly a crisis and that number is likely a wild exaggeration, especially since no one seems to have come up with a reliable way of determining exactly which readmissions actually should have been avoided.
This is a curious topic for an employer group to be focused on. As the report notes, it is likely that only a small portion of preventable readmissions are paid for by commercial insurance. Employers should be far more worried about the effect on their costs from continued hospital/physician consolidation and cost-shifting due to inadequate Medicare and Medicaid reimbursement. The report’s brilliant observations include that fixing readmissions is likely to be a complex process which may require clinical process reengineering and better care transitions and coordination; better data to help identify the cases most likely to end up as readmissions would be useful; and getting employees engaged and aware of factors that may lead to their being readmitted would also be helpful. Unfortunately this waste of time, energy, money and paper would have better been spent creating a system to identify readmission by readmission those that truly were avoidable.