WellPoint affiliates are PPO plans, HMO plans and PDP plans with a Medicare contract. Enrollment in WellPoint affiliated plans depends on contract renewal.1 Jencks SF, Williams MV and Coleman EA. “Rehospitalizations among Patients in the Medicare Fee-for-Service Program.” New England Journal of Medicine, 360(14): 1418-1428, April 2, 2009.
Imagine you’ve been in the hospital. You’ve eagerly waited for the day you could go home. When that day finally arrives, you’re thrilled. It’s a safe bet the last thing you want to do is to have to return to the hospital. Unfortunately, far too many people are returning to the hospital after receiving care there, particularly seniors. According to a study published in the New England Journal of Medicine, nearly one‐fifth (19.6 percent) of traditional Medicare beneficiaries who had been discharged from a hospital were re‐hospitalized within 30 days, and 34 percent were re‐hospitalized within 90 days. 1 The Medicare Payment Advisory Commission has estimated the cost of hospital readmissions at $15 billion. “We know that many of these instances are unavoidable,” said Dr. Mary McCluskey, chief medical officer of WellPoint’s Government Business Division. “However, some are preventable, which is unfortunate since hospital stays can expose patients to a host of complications, including possible infections, as well as being costly, stressful and inconvenient.” WellPoint, which serves thousands of seniors through its affiliated Medicare plans, offers the following tips for making sure a hospital stay doesn’t end up turning into a roundtrip. Understand discharge directions. The transition home really starts before the patient leaves the hospital. It is critical to understand hospital discharge directions. This isn’t as easy as it sounds since patients may be medicated, stressed, groggy or confused. For that reason, it is recommended that patients repeat instructions to their physicians to make sure they understand them. It also may help to write down the instructions or enlist a family member or caregiver to help document them. Another way for a patient to smooth the transition home is to make sure someone at the hospital contacts their primary care physician (PCP) with information about their condition and treatment. People with chronic conditions see many different doctors. It is important for those doctors to communicate with each other. Fill prescriptions and take them as prescribed. Upon being discharged from the hospital, it is important to fill prescriptions immediately and take them as prescribed. Patients should make sure to understand the timing, dosage and frequency of each drug. Also, patients should take care to understand how existing medicines, including over-the-counter drugs, interact with new drugs. Finally, if any drugs have been stopped, it’s important to ask why. It may be helpful to get a pill organizer to keep track of medicines. Get follow-up care. According to America’s Health Insurance Plans (AHIP), half of patients who were re-hospitalized within 30 days did not have a physician visit between the time of discharge and re-hospitalization, suggesting one of the reasons people end up back in the hospital is lack of follow-up care. That is why it’s so critical for people to transition from the hospital to their PCP. Patients should schedule follow-up appointments with their regular doctor and keep them. The PCP can coordinate care, making sure patients aren’t exposed to dangerous drug interactions or unnecessary tests. Anyone with trouble getting a timely appointment can call their insurer for help. Eat properly. People recently discharged from the hospital need to get proper nutrition, including following any dietary restrictions. Appetite is often suppressed after an illness; however, if someone is too sick to eat due to pain, nausea, inability to swallow, etc., then they should contact their doctor. Take advantage of programs that are there to help. People with Medicare Advantage plans may have access to resources, including case managers, to help them return safely to their homes. Case managers may be able to help a recently discharged patient find transportation to doctor appointments, address potential safety issues in the home and help them locate community programs offering everything from meal delivery to free or discounted medicines. These people are experts at understanding the system and it is their job to help. Know when things aren’t getting better. Patients should understand which symptoms require immediate intervention and return to the hospital, if necessary. People who aren’t getting better shouldn’t wait for their next appointment. Be an engaged consumer. Many trips to the hospital occur without warning. However, people with advance notice have resources available to help them research quality and cost. Information about readmission rates for certain hospitals, for example, is available at www.hospitalcompare.hhs.gov, where visitors can enter a procedure and a zip code, select three hospitals, and click “Outcome of Care Measures” to compare results. “Most of us will have to go to the hospital at some point in our lives,” said McCluskey. “The key is being an engaged patient to prevent hospitalization from becoming a downward spiral, both physically and financially.”