Friday, April 03, 2009

One in Five Medicare Patients Wind up Back in the Hospital

This is from my morning newspaper read. Actually, yesterday's read. According to a report published in the New England Journal of Medicine, one out of five medicare patients discharged from hospitals end up being readmitted within a month's time. According to Stephanie Nano of the Associated Press, the study's findings suggest that A) medicare patients are not being given sufficient instructions as to how and when to take their medications and B) followup doctor visits are not being scheduled. The result? Discharged medicare patients get confused about their medicine regimens and fail to take the necessary steps to manage their conditions. They also fail to get followup treatment.

I'm no seer; however, I have some inklings as to what the problem is and my feelings are based on my own experiences with hospitals--not me, knock on wood, but, rather, taking my mother (68) in for treatment and assisting a friend who had to regularly take her mother (71 at the time) in for followup treatment to an oncology ward. In essence, each time I've made visits to institutional medicine settings (hospitals versus a doctor's office), I've found that quality care does not seem to be a high priority for doctors, staff, and management. Why that is the case is another matter entirely, of course, and would take up hundreds of blog pages. However, regardless of the reasons why and how the situation degraded to this point, hospital care has become a shoddy enterprise.

Here's an example: when my friend's mother was ill, she was seen at Duke University Medical Center, which maintains a cancer treatment center. Duke is highly thought of. However, not so much by me. On every single visit in which I accompanied my friend and her mother, I found that, despite the fact that my friend had given the staff a complete list of her mother's current medications and the meds that she could not tolerate, no record of this was ever maintained. My friend had to keep giving this information on each repeat visit...leading me to wonder what happens to elderly people who do not have the benefit of being accompanied to a hospital by a friend or relative who has some knowledge of their condition.

That's just one example. However, I can think of others regarding my own mother and they all lead me to one conclusion: quality care is not as important as making the numbers balance out.

In the case of the 20 percent of medicare patients who get discharged without proper followup scheduled and without proper discharge preparation, I have to wonder if the true desire is to get medicare patients out of the facility as soon as possible simply to get higher billable patients in.

I contrast this type of behavior to my own internist, or treating physician, who, though busy, seems to take as much time as needed with his patients and even makes followup phone calls to his patients to check on them (uncommon, I know). That, ideally, is how medicine should operate. As a system of care where the notion of providing quality care is the preeminent concern.

But, sadly, that's not where our society is going. And where it will end up, who can say. But with an aging U.S. population, changes have to happen or...pretty much everyone is out of luck at some point.

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