Quantifying the Risk for Hospital Readmission When Physical Therapist Discharge Recommendations Are Not Followed

Abstract

Nearly a fifth of all hospitalized patients are readmitted within 1 month of discharge. 1,2 Unplanned hospital readmissions lead to both poorer patient outcomes and increased health care costs. 1,3 Readmitted patients risk exposure to hospital-acquired infections and medical errors, as well as the potential for delirium, frailty, and mortality. 4,5 The US health care system spends billions of dollars on readmissions. 6,7 These costs, of course, are carried by patients, facilities, third-party payers, and tax payers as a whole. 7-9 Some readmissions appear to be preventable. 7,9,10 Inadequate care during a hospital stay and during the transition period at discharge impacts recovery and the potential for hospital readmission. [11][12][13] Infection, obstruction, respiratory problems, bleeding, and falls are some of the reasons preventable readmissions may occur. [14][15][16] To reduce readmissions, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Readmission Reduction Program. 17 This program penalizes and incentivizes hospitals to decrease unnecessary readmissions during the 30 days following hospital discharge. 18 On average, readmission penalties cost each hospital $200 000 annually, while incentives can reward hospitals between $10 000 and $60 000 for each avoided readmission. 19 Hospitals have responded to these incentives in different ways. 20 Some have trialed postdischarge programs including follow-up telephone calls to patients from hospital staff, patient-activated hotlines, timely communication between hospital providers and ambulatory providers, timely ambulatory provider follow-up, and provider home visits. 21,22 Others have implemented