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Counting the Cost of Miscommunication: Hospitals Fined for Readmission Rates

Hospitals nationwide are facing increased fines under a portion of the Affordable care Act. In 2014, more than three-quarters of hospitals subject to the new regulations – over 2,600 facilities nationwide – failed to meet the Act’s criteria, and will face stiff financial penalties.

Defining the Problem

The fines are levied against facilities with high rates of readmission for Medicare patients – that is, patients return for additional treatment of the same issue within 30 days of release. The consequences are significant, and come in the form of Medicare cutting their reimbursement to hospitals for treating Medicare patients. Depending on their readmission rate, hospitals can lose up to three percent of their reimbursement – up from a maximum two percent last year, and a significant loss for large facilities which treat thousands of Medicare patients annually.

If the penalties seem severe, consider that the readmission issue they seek to correct is equally daunting: the Center for Medicare Services estimates that of the $26 billion Medicare pays in readmission costs annually, the majority – upwards of $17 billion in taxpa yer dollars – is paid to cover avoidable readmissions.

 

Causes of Readmission

The problem does not appear demographically neutral; according to the recent Influence of language barriers on outcomes of hospital care for general medicine inpatients, non-English speakers, particularly Latino and Chinese patients, are readmitted at a significantly higher than is the general population. A review of 10.7 million hospital records for Medicare patients, conducted by the Dartmouth Atlas Project for their 2013 paper, Care About Your Care, revealed the top five reasons a patient may be readmitted:

  1. Patients may not fully understanding what’s wrong with them
  2. Patients  may be confused over which medications to take and when
  3. Hospitals don’t provide patients or doctors with important information or test results
  4. Patients do not schedule a follow up appointment with their doctor
  5. Family members lack proper knowledge to provide adequate care

The common thread? Miscommunication. To avoid a return trip to the hospital, a patient needs very clear information prior to being discharged. Which tests were run? What were the findings? What is the diagnosis? What medication/follow-up care is need? The answers to these questions can be difficult for anyone to understand, and those with limited proficiency in English face the additional hurdle of a language barrier. Hospitals are scrambling to better address this issue, both to avoid the Medicare penalty, and out of concern that private health insurers may also cut payments for readmissions deemed unnecessary.

 

Solutions for Success

Given the top causes of readmission involve miscommunication, and with non-English speakers overrepresented in this issue, any viable fix must target the limited-English population. Fortunately, solutions are available; interpretation options continue to expand, with vendors offering over-the-phone, video remote, and contracted in-person interpretationoptions, as well as written translations. Choosing an interpretation service wisely is essential for success, as accuracy and interpreter availability are key in effective communication with non-English speakers. Used effectively, these services can help hospitals ensure that their patients truly understand their condition, the treatment they’ve received, and the steps they can take to promote a full recovery, free from an unnecessary readmission.

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