Too Many Patients Are Going Home from the Hospital Unsupervised

Filed under Articles
Originally published in Market Research Letter: January/February 2011

Because of the Affordable Care Act, hospitals have become increasingly interested in preventing readmissions. Two of the most commons reasons for hospital readmissions are medication errors and failure to see a physician – both of which could be reduced if patients were supervised through home care visits after discharge. In this month’s Metrics Matter, we analyze hospital discharges to self-care for the major diagnostic related groups (DRGs) to determine whether there is opportunity to change discharge patterns and ultimately reduce hospital readmissions.

Healthcare Market Resources studied the hospitals in the ninetieth percentile for each major DRG that sent the highest percentage of patients to home care. In our study, we found these hospitals that discharged more patients with a home health referral sent fewer patients home to unsupervised self-care by a significant amount. We call these hospitals our “Top Performers.” This designation also indicates that these top-performing hospitals aren’t simply substituting nursing home care or institutional care for home care.

Percentage of Discharges to Self-Care

Using 2009 Medicare Claims, Healthcare Market Resources determined the 11 most common DRGs, which are the basis for Medicare hospital reimbursement. Then we calculated this metric for each of these DRGs as:

The percentage of patients discharged to self-care by our top-performing hospitals divided by the national average for all hospital patients discharged to self-care.

Therefore, the lower the percentage for each DRG, the greater the opportunity to favorably change discharge patterns by decreasing the number of patients discharged to self-care.

Based on our analysis, we can conclude the following:

  • At 23.1%, the diagnosis of major joint replacement or reattachment of lower extremity has the lowest percentage and thus the greatest opportunity for change in hospital discharge patterns.
  • Patients with severe septicemia or sepsis demonstrate the highest percentage (86.8%) in this metric, indicating fewer patients with this diagnosis are discharged to self-care.
  • Of particular note is that both acute myocardial infarction (63.3%) and heart failure and shock (63.8%) demonstrate the second and third lowest percentages in this metric, respectively. Both of these diagnoses are among the DRGs for which hospitals could be severely penalized for readmission within 30 days of discharge. In other words, hospitals are unnecessarily increasing their risk of readmission by sending too many patients with these diagnoses home to unsupervised self-care.

After hospital discharge, unsupervised self-care patients have a much weaker support system to ensure that they promptly see a physician and are compliant with their medication regimen. This metric indicates that there is opportunity for home care agencies to help hospitals reduce their risk of readmission of patients diagnosed with acute myocardial infarction or heart failure and shock – two DRGs associated with Medicare payment penalties for readmission.

Click here or call 215-657-7373 to learn more about this metric and the many ways you can use Healthcare Market Resources’ data to help identify growth opportunities for your organization.