Which Patients Will Hospitals Focus on?

Patients come to hospitals with a range of conditions which might bring them back later. Medicare provides software to predict which are most likely to come back.

To see how hospitals are affected, here is a simple example of

• 20 patients with 15% chance of readmission, so 3 return, and
  
• 20 patients with 35% chance of readmission, so 7 return

If this hospital makes no special efforts, it would have a total of 10 readmissions. Assuming other US hospitals reduce total readmissions 20% as Medicare wants, the new national average and the penalty cutoff will drop to 8, and our hospital above will pay for 2 penalties over the new national average.

To reduce readmissions, a hospital needs to put effort where it has the best chance of reducing them. Working on the 20 patients who have 3 readmissions among them has little payoff. Working on the other 20, who have 7 readmissions among them, has a much better chance of avoiding some readmissions.

Part of the effort will be to cure patients well and refer them to good follow-up care. This has limited potential, because hospitals have little influence on patients after they leave.

An additional approach is to convince patients not to seek treatment any more, and hospice groups vocally support this direction. Every extra health problem raises the patients' odds of readmission and also raises their vulnerability to pressure for comfort care, "Do Not Resuscitate" orders and hospice. The line between appropriate advice and inappropriate pressure is easy to cross when hospitals have strong financial incentives.