Fannie Fang
Executive Editor
Loyola University Chicago School of Law, JD 2017

 

CMS has reported that Medicare expenditures amount to roughly 17 billion a year on patient readmissions alone. Studies show that almost twenty percent of all patients who are admitted to a U.S. hospital makes a repeat visit within thirty days of discharge. High readmission rates in U.S. hospitals, directly causing increasingly excessive medical expenditures has become a concerning issue that needs to be addressed.

The reason behind this trend is due to the lack of effective communication between patients and doctors, or physicians and primary care providers. Fortunately, since the enactment of the Affordable Care Act, many health care providers have started to recognize that healthcare reform is not only about reducing medical costs, but also closing gaps in communication among health care providers and patients in order to lead to improved quality, safer discharges, and a decreased readmission rate.

Correlation between communication and readmission rate

In recent years, many studies have demonstrated the apparent correlation between communication between doctors, primary care physicians, and patients with hospital readmission rates. For example, one study published in the Journal of Hospital Medicine revealed that in hospitals that have a high readmission rate, direct communication from doctors to primary care physicians occurred only three to twenty percent of the time at discharge.

In addition, Annals of Internal Medicine published a research study where they found that less than one third (12 to 33 percent) of the participating primary care physicians had access to their patients’ discharge summaries at the time of their patients’ first post-discharge visits. This failure in communication could leave primary care physicians unaware of critical information including, but not limited to, a patient’s diagnosis, potentially actionable test results, reconciled discharge medications, mandatory follow-up care and test results. As a result, primary care physicians are unable to provide high-quality care that ensures full recovery.

Furthermore, studies show that communication between doctors and their patients can directly affect the readmission rate. This is because frequent communication between doctors and patients allows patients to understand their treatment options, modify their behaviors accordingly, and follow their medication schedules.

What providers can do to improve the lack of communication

Good communication among and between hospitalists, primary care physicians and patients during the discharge period is imperative to boosting patient safety and reducing the likelihood of an unplanned trip back to the hospital.

First, readmission rates could be reduced if doctors spent time communicating with the patients before the final discharge so that he or she may create a discharge instruction individually tailored to that patient’s specific needs. Next, once the primary care physicians receive the first discharge instruction, he or she should also spend time communicating to the patients about the specific ways that can help them manage their health better and prevent them from revisiting the hospital. Furthermore, doctors and primary care physicians should uphold the responsibility to encourage their patients to ask questions. Studies show that patients are often more inclined to communicate with their doctors or physicians when they are encouraged to speak up. As a result, simple steps such as sitting next to a patient instead of standing away from them can encourage open communication and thus create positive outcomes.

What Can Compliance Officers Do?

In order to facilitate better lines of communication and thus reduce hospital readmission rates, as a compliance officer it is important to develop and implement policies and procedures to promote these goals. Here, the compliance officer must implement high reliability systems that will improve discharge communication and the transitions of care. In addition, he or she must learn to conduct effective training and education to raise awareness of the importance of effective lines of communication. The ideal systems will enhance communications between the hospitalists, primary care physicians, and patients. More importantly, the systems will help to limit unnecessary readmission, improve quality and decrease adverse events.