Sunday, April 12, 2009

Misdirected Heat IT Funding Chapter II

I never think of the future. It comes soon enough.

Albert Einstein

 

 

....There are other ways to utilize HIT in direct patient care that would create enormous dividends and decrease medicare and private payments to hospitals.

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The Silver Bullet Approach

A recent study revealed that a great number of medicare beneficiaries are re-admitted to hospital within 30 days of their discharge due to inadequate post discharge followup.

The study published by the New England Journal of Medicine   states,  "Twenty-two per cent of Medicare hospitalizations were followed by a readmission within 60 days of discharge. Medicare spent over $2.5 billion per year (24 per cent of Medicare inpatient expenditures) on such readmissions between 1974 and 1977.  This study  supercedes similar studies in 1994-1996, and 1984-1986.  The study cohorts are not similar in demographics or provider institutions and may not be comparable.

In this study, the cost of unplanned overcapitalization in 2004 was estimated to account for US$17.4 billion of the $102.6 billion in hospital payments from Medicare. A large percentage of bounce-back admissions appear to be related directly to poorly coordinated transitions of care. Given that a woeful percentage of patients attend follow-up visits, tremendous  improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge.

Other articles explain how medicare's prospective payment as well as  DRG reimbursement plan has created this image

difficulty and increased expenditures,and how improvement might be possible if patients were seen by their primary care physicians within a few weeks after discharge.  (Does a shorter hospital stay reduce costs and/or increase readmission rates. ) Are patients stable on discharge?

Would HIT spending in this area, applied in a systematic way reduce these expenditures?  Why spend it all on EMR and HIE?

Richard Reece MD, who writes in Medinnovation Blog elaborates on how these billions of dollars might well be apportioned more wisely.

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