Primary care follow-up within 7 days of hospital discharge reduces readmissions, cost
New research published in JAMA suggests primary care follow-up within seven days of a hospitalization is associated with fewer Medicaid readmissions.
In a single year, the U.S. population had a collective hospitalization bill of $381 billion. Readmittance rates added another $16 billion in healthcare costs annually. To address the skyrocketing costs and in an effort to improve the quality of care, the CMS Hospital Readmissions Reduction Program (HRRP) was developed. Though, there is still some debate as to whether hospital readmission rates have truly improved under the HRRP.
The researchers, led by Dawn Wiest, PhD, of the Camden Coalition of Healthcare Providers, sought to determine the efficacy of their 7-day pledge program, which aims to avoid hospitalizations in the city of Camden, New Jersey, by “removing barriers to rapid primary care follow-up after patients are discharged from the hospital.
In this retrospective study, Wiest and colleagues assessed hospitals with more than 2,500 readmissions between January 1, 2014 and April 30, 2016. They linked payer claims from four separate healthcare systems to insurers’ lists of patients who were also patients of Camden-based primary care practices to determine hospital use before and after discharge.
A total of 1,531 records were classified by timing of a primary care appointment post hospital discharge. Discharges followed by a primary care appointment within seven days of discharge were matched by propensity.
The treatment cohort comprised of 450 discharged patients and the non-treatment cohort consisted of 1,081 patients. The 7-day pledge program had fewer 30- and 90-day readmissions compared with patients with less timely primary care follow-up or no follow-up at all. Specifically, the researchers found:
- Of the 450 hospitalizations in the treatment group, approximately 13 percent were followed by any readmission within 30 days versus 18 percent among matched referents.
- At 90 days post hospital discharge, 28 percent of hospitalizations in the treatment group were followed by any readmission, compared with 39 percent among matched referents.
Though these types of programs tend to be costly, the researchers found approximately $10,300 in savings can be achieved for every avoided hospitalization. Furthermore, the program would recover costs if 27 inpatient admissions were avoided per year by connecting 208 patients to primary care within 7 days of hospital discharge.
“Programs such as the 7-day pledge may be associated with a reduction in preventable hospital admissions through patient and practice engagement, providing incentives to patients to overcome barriers to keeping an appointment, and adequately reimbursing practices on top of regular reimbursement and value-based payments to prioritize appointments for recently discharged patients,” Wiest et al. concluded.
As a senior news writer for TriMed, Subrata covers cardiology, clinical innovation and healthcare business. She has a master’s degree in communication management and 12 years of experience in journalism and public relations.