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Preventing Rehospitalizations, Part 1


One of the greatest opportunities for home care agencies today is to reduce hospital readmissions. Agencies should seize the opportunity to partner and build relationships with hospitals, rehab centers and ACOs to help alleviate the penalties hospitals face for patients being readmitted within 30 days of discharge.

These readmissions can costs the healthcare system up to $41 billion in hospital costs every year. Home healthcare is perfectly positioned to prevent these readmissions by recognizing the signs that could lead to rehospitalization, and sometimes even perform some of the same tasks that can be done in a hospital. All while keeping the patient in the comfort of their own home.

Some of the most usual suspects that drive hospital readmissions are:

  • Acute myocardial infarction
  • Heart failure
  • Pneumonia
  • Chronic obstructive pulmonary disease (COPD)
  • Hip and knee replacement
  • Coronary artery bypass graft

And patients who require even more intense monitoring include those with multiple co-morbidities such as of heart failure, diabetes, COPD, hypertension and Alzheimer’s disease.

As clinicians, it is our honor and duty to be good stewards of healthcare dollars and to do all within our power to keep patients comfortable, which usually means keeping them out of the hospital.

Decreasing the burden of the cost of hospital readmissions and improving our patient’s experience under our care is of paramount importance.  This blog series will explore how we can work with the discharging hospital and our home health staff to be effective members of the care transition team.

The next entry in this series will focus on how a home health agency can work with a hospital during discharge, sharing responsibility for the smooth transition to home health.

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