Article Revised: March 26, 2019
A study reported in the April 2, 2009 New England Journal of Medicine discovered that one in five Medicare patients are readmitted to the hospital within 30 days of being discharged—and one in three are back within 90 days—in large part because they lacked a primary care provider, according to a new national study released Wednesday. More than half of the nonsurgical patients in the study had not seen a doctor prior to being re-hospitalized.
I don’t doubt the reported numbers, which are absolutely horrific, but I have my doubts about the causes and the proposed fixes. Healthcare has seriously lagged behind other segments of the economy in its adoption of quality, Lean and Six Sigma methodologies. The healthcare sector’s costs continue to skyrocket and consume an ever larger share of GDP, and patients continue to suffer the consequences. Readmissions are the healthcare equivalent of field failures. If any manufacturer had numbers like this, they’d be out of business within months.
An earlier post on this site reported that hospitals kill an estimated 98,000 patients per year, with some estimates double that number. That’s like a jumbo jet crashing and killing 400 people every day. Now we learn that even those patients who escape the hospital alive will very likely need to return soon after their discharge. Apparently the healthcare system’s failures extend to so-called “care” of patients outside the hospital walls as well as inside. In the meantime, healthcare providers continue to make money fixing problems they either caused or could have prevented. If things don’t change soon, the price of all of this may become more than society can bear.
Six Sigma and other quality improvement tools have the potential to change this bleak situation. I have data from a study where a very simple process change reduced the readmission rate for Medicare Med Surg patients from 28% to 10% in less than one year. As a result the admissions per thousand insured members dropped from nearly 230 to around 120. The question is: do hospitals view this as an incredible accomplishment, or lost revenue? We owe it to ourselves to design a system that assures the former conclusion.