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NEW YORK (MainStreet) — Hospital readmission rates have come into the spotlight in recent years as healthcare costs to the government have come under increased scrutiny. Nearly 20% of Medicare patients are readmitted to the hospital within 30 days of discharge. The price tag for preventable readmissions is hefty, costing Medicare alone about $12 billion annually.

The Affordable Care Act (ACA) attempts to address this problem by imposing payment penalties on hospitals with high readmission rates for specific conditions. Hospitals have responded by implementing strategies. One such strategy has been to not admit certain patients but rather to categorize them as outpatients, so that if they return within 30 days, they will not be considered readmissions.

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However, some hospitals have taken a more patient-centered approach to fixing, rather than evading, the problem.

"Too often, people leave the hospital in a flurry of discharge activity, only to find they don't know what to do when they get home," says Angela Macey-Cushman, a nurse attorney at Morrow Kidman Tinker Macey-Cushman.

Missed discharge instructions leave both the patient and healthcare system vulnerable, says Cheryl Bailey, chief nursing officer and vice president of patient care services at Cullman Regional Medical Center.

A study published in the Annals of Internal Medicine in 2009 shows that patients who understood their discharge instructions and who were prompted by medical professionals, among other tactics, were 30% less likely to end up in the emergency room or be readmitted to the hospital within 30 days of discharge.

Cullman Regional Medical Center created a similar program that resulted in a 15% reduction in readmission rates within 6 months of initiation. At discharge, a nurse uses an iTouch device to record discharge instructions while the patient listens. Afterwards, the nurse asks the patient to listen to the recorded conversation to clarify any confusion.

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In addition to the recorded instructions, instructional care videos, pictures, educational documents and task lists are also uploaded into the app. The patients are also sent emails, text reminders, tasks and care messages.

Patients and their caregivers are able to access the discharge instructions via computer, mobile device or landline phone. A nurse monitors patient retrieval of instructions and watches for risk factors of patients most at risk to be readmitted.

Mercy Health in Cincinnati brought down its readmission rates for heart failure, pneumonia and acute myocardial infarction by 15% in the first 10 months of 2012 and got 61% of these discharge patients to visit their primary care physician within 7 days of discharge by using the nurses to act as patient guides during the discharge process.

Subsequent to discharge, a nurse stays in communication with the patient, beginning with a home visit within the first three days of discharge during which the nurse ensures the patient understands his or her medication regiment. The hospital found that key to success was the nurse ensuring that follow-up visits to the patient's primary care physician were scheduled and that the patient was able to get to appointments.

Many hospitals do not have special programs in place to reduce the number of readmissions, but patients and their caregivers can take steps to lessen the likelihood of readmission.

"I advise everyone to make sure they understand all of the discharge instructions," says Macey-Cushman. "Where will they pick up the prescription medications they should take at home? Do they need to contact the home health nurse, or has that service already been arranged? When will the follow-up appointments occur, and who should the patient or family call if something comes up before that time?"

Macey-Cushman warns that surgeons sometimes prescribe high doses of pain medications to patients while they're in a hospital and cut the dosage upon discharge. "This can lead to withdrawal symptoms and overuse," she says. She advises asking for clear instructions on the use of pain medications and asking what to do if the patient is still having pain.

--Written for MainStreet by S.Z. Berg, author of College on the Cheap