Why should hospitals care if a homeless, psychotic patient has a decent place to live after that person is discharged?
Because if they don’t, it’s going to cost them money.
Section 3025 of the Affordable Care Act established the Hospital Readmissions Reduction Program, which penalizes hospitals for “excess readmissions.”
What is an “excess readmission?”
As defined by the act, an excess readmission happens when someone is re-admitted to a hospital for treatment of the same health problem within 30 days after they were discharged.
Last year 2,610 hospitals were fined an estimated $428 million dollars. And the number and the amount of fines have been increasing in the two years since the government first began penalizing hospitals. Last year, nearly 18% of Medicare patients, who had been hospitalized, were readmitted within a month. That’s roughly two million patients, costing Medicare an estimated $17 billion in potentially avoidable readmissions.
Who are some of these patients?
We know that many of them are so called “frequent flyers,” a derogatory term used to describe individuals who are seriously mentally ill, homeless, and have addiction issues. My friend, Florida Judge Steven Leifman, offered some alarming statistics about frequent flyers when he testified before a House committee last year.
“The Florida Mental Health Institute at the University of South Florida completed an analysis examining arrest, incarceration, acute care, and inpatient service utilization rates among a group of 97 individuals in Miami-Dade County identified to be frequent recidivists to the criminal justice and acute care systems. Nearly every individual was diagnosed with schizophrenia, and the vast majority of individuals were homeless at the time of arrest. Over a five year period, these individuals accounted for nearly 2,200 arrests, 27,000 days in jail, and 13,000 days in crisis units, state hospitals, and emergency rooms.”
13,000 days in medical facilities!
One of the joys that I have in my life is serving on the board of the Corporation for Supportive Housing, a national non-profit that looks for creative ways to end chronic homelessness. Last week in Denver, I got to hear my fellow board member, Dr. Jim O’Connell, speak about innovative respite care programs in Boston. O’Connell is president of the Boston Health Care for the Homeless Program and he spoke eloquently about how important physical health care is for persons who are homeless.
It was a landmark study by O’Connell published in 2005 that showed the leading causes of death among the homeless were heart disease, cancer, liver disease, pneumonia, tuberculosis and kidney disease. Persons who are homeless have a higher number of skin infections and HIV/AIDs. They are six times more likely to become sick and because the chronic homeless spend most of their time living on the streets, they are at high risk for frostbite and hypothermia, especially during the winter or rainy periods.
One study found that individuals who are homeless are eight times more likely to die from a medical problem than from their mental illness or addiction.
A recent study published in the Journal of General Internal Medicine found that 67 percent of homeless patients surveyed spent their first night after hospital discharge at a shelter. Worse, 11 percent spent their first night after discharge on the streets.
Medicare’s new “excessive readmission” programs should motivate hospitals to think beyond the discharge door. What makes more sense: paying millions in penalties or helping fund services that will reduce readmissions and improve health care in the community?
The revamped Helping Families in Mental Health Crisis Act that Rep. Tim Murphy (R-Pa) introduced recently contains a provision that has been largely overlooked because of the legislation’s more controversial features. His act would require hospitals to develop and implement discharge plans for Medicare patients and would require hospitals to connect those patients with community services.
Tomorrow (Tuesday June 16), Rep. Murphy will hold a hearing about his bill. The provision that would require hospitals to do discharge planning and connect frequent flyers with community services is something everyone should endorse.
About the author:
