Healthcare systems today have embraced early readmissions—defined as admission within 30 days of discharge—as a valid metric for quality of care (JAMA Otolaryngol Head Neck Surg. July 23, 2015. doi:10.1001/jamaoto.2015.1323). Unplanned hospital readmissions are costly, can reflect poor quality index hospital care, and can lower patient quality of life, said Peter T. Dziegielewski, MD, assistant professor in the department of otolaryngology at the University of Florida in Gainesville.
Explore this issue:October 2015
In 2009, the Centers for Medicare and Medicaid Services began requiring hospitals to publically report their readmission rates and, in 2013, instituted financial penalties for medical facilities with 30-day readmissions that were associated with myocardial infarction, pneumonia, and heart failure. In 2015, the Hospital Readmissions Reduction Program (HRRP) of the Affordable Care Act expanded the scope to include surgical procedures.
Partnering with Community Physicians
In light of government standards and with ongoing efforts to improve quality of care, what are some best practices to reduce hospital readmission rates for otolaryngology patients?
Eric Genden, MD, chairman of the department of otolaryngology-head and neck surgery and director of the Head and Neck Institute at Mount Sinai Health System in New York City, advises perfecting care across the continuum. “The fact that academic centers and community physicians are two separate entities significantly contributes to readmissions,” he said. His center implemented three programs in the last seven years that have lowered readmission rates substantially. The programs strongly rely on the hospital’s relationship with community physicians.
Specifically, the center partnered with community otolaryngologists, including the largest otolaryngology community group in the country—ENT and Allergy Associates, with 40 locations in the New York tri-state area—along with radiation oncologists and medical oncologists.
“As part of these partnerships, we trained community physicians to screen and work up (e.g., perform a physical examination and medical history, radiographic assessment, and/or needle biopsy) on patients with head and neck cancers,” Dr. Genden said. “This expedited the diagnosis in the community and limited the cost of the workup because the appropriate tests are done the first time around as opposed to inappropriate testing and redundant testing.”
The center also partnered with community physicians on a same-day appointment process, so that patients with head and neck disease seen in the community could be transferred for therapy right away, which also expedites care. Community partners work with the hospital on surveillance protocols and post-therapy management when a patient has a minor or moderate complication. By enabling a patient to reach out to a community physician who can take care of a problem early in the process, problems can be better managed, and readmissions are prevented.