Intelligence Resource Center

Lisa Remington

Lisa Remington, President, Remington Health Strategy Group

In This Issue

MarketScan: Payors Expanding Into Palliative Care

The Paradigm Shift for Hospice Providers Begins

Readmission Analysis By Payor: Seven and Thirty Day By Diagnosis

Study: Community-Based Linkages To Population Health

What Does A Unified PAC Payment System Look Like?

Episode-Based Vs. Stay Based Payments: Discussions for Future Payments

2019 Guidelines for Home and Community-Based Services

Home Care For Hip And Knee Patient: How Do Physicians Decide About Where Patients Should Go?

How ACOs Manage High-Risk, High-Need Patients

Physician Chronic Care Management (CCM): New Opportunities for PAC Partnerships

Six Ways PAC Providers Can Partner With Physicians Under Alternative Payment Models (APMs)

16 Things To Know About Stark Laws

Patient Activation Measures For High-Risk Patients

Readmission Data For All Cause 7-Day and 30-Day

The Five Barriers to Accessing Palliative Care

Home-Based Palliative Care Models

Emergency Dept. Study: Top 10 Reason Heart Failure Patients Go To The ED

Study: Readmission After Ambulatory Surgery For Seniors Leading To 30-Day Readmits

Medicaid and Medicaid Managed Care Models Prepare For Value-Based Models

22 Key Facts About Physician CCM Billing

ACOs: Three Approaches To Improve End-of-Life Care

Behavioral Health Report: Effective Integration For Seniors With Depression

Which Patient Populations Cause The Highest Readmissions?

Hospice Study: Increasing Hospice Decreases Hospital Readmissions Among All Nursing Homes

Study: Hospice Top 13 Diagnosis

The ACO Medicare-Medicaid Model For Managing High-Risk Patients

Primary Care Is Driving Care Coordination: Market Changes Ahead

Montefiore Health System’s Care Management Program

Aetna’s Compassionate Care Program for Advanced Illness

Nine Building Blocks of Care Management

Housecalls - A Physician's Perspective

Physician Practice Transformation: A Primer on MIPS and APMs

MEDICAID ACO Market Scan

Care Coordination High Priority For Bundled Payment Models

Payor and Physician Models For Chronic Care Management

Quality Measures Development The IMPACT Act

Physician Leadership: Why Post-Acute Integration Matters

ACO Investment Model

What Is The Definition Of Patient Centered-Care?

MedPAC: Unified Post-Acute Payment Within Reach

ACOs: Lowering Medicare Spending Per Beneficiary for High-Need Patients

Community-Based Services: Paramedics New Role

Palliative Care and Cancer Insights

Discharge Planning Framework Under The IMPACT Act

Home Health Agency Value-Based (HHVPB) Model Background

The IMPACT Act Quality Measure Domains

IMPACT Act – Cross-Setting Standardization For Skin Integrity

IMPACT Act – Cross-Setting Quality Measure For Medication Reconciliation

Medicare Advantage vs. Medicare-Fee-For Service Longitudinal Site Of Death Study

The IMPACT Act Unifies Payment System For Post-Acute Providers

- Back to Full Issue -

Patients 65 and older who have ambulatory surgery are much more likely to be readmitted to the hospital within 30 days than younger patients, regardless of their health before surgery, reports a new, large national Northwestern Medicine study.

Study Results

The study on senior hospital readmissions, which was published in the August 2015 issue of the Journal of the American Geriatrics Society, examined data from 53,667 patients who underwent ambulatory surgery in academic medical centers. The authors used the 2012 National Surgical Quality Improvement Program data set.

Over a 30-day period, seniors were 54 percent more likely to be readmitted to the hospital compared to patients younger than 65 years, the study reports, after accounting for differences in other medical problems. The problem is likely to worsen as economic pressures to reduce health care costs lead to even more complex surgeries in an ambulatory setting, the authors said.

“These seniors were supposed to stay out of the hospital since the procedures were performed in the ambulatory setting, but they were admitted to the hospital within 30 days,” said corresponding study author Dr. Gildasio De Oliveira Jr. “Age was the biggest factor associated with readmission and complications. It’s not because they are sicker, it’s because they are older and have trouble understanding their discharge instructions and medication dosing, which often are not clearly explained.”

De Oliveira is an assistant professor at the Center for Healthcare Studies at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital. “Over a 30-day period, seniors were 54 percent more likely to be readmitted to the hospital compared to patients younger than 65 years, the study reports, after accounting for differences in other medical problems.”

“These seniors were supposed to stay out of the hospital since the procedures were performed in the ambulatory setting, but they were admitted to the hospital within 30 days,” said corresponding study author Dr. Gildasio De Oliveira Jr. “Age was the biggest factor associated with readmission and complications. It’s not because they are sicker, it’s because they are older and have trouble understanding their discharge instructions and medication dosing, which often are not clearly explained.”

To prevent costly readmissions, seniors need clearer, more understandable discharge instructions and to be evaluated for their ability to care for themselves after surgery, said De Oliveira, who also is an assistant professor in anesthesiology at Feinberg.

Economic pressures to reduce health care costs have resulted in a 300 percent increase in ambulatory surgeries over the past decade. Now more than 70 percent of surgical procedures are performed in an outpatient setting, including more complex surgeries, such as hysterectomy, spine surgery and thyroid surgery. About 9 million ambulatory surgeries annually are performed on patients 65 and older.

“When patients are sent home on the same day, a lot is required of them to take care of themselves, and it’s beyond the capability of a lot of older individuals,” De Oliveira said. “They have to administer opioids and monitor themselves for emergency problems such as bleeding or infection.”

Seniors, of whom 44 percent have low health literacy, may have difficulty understanding how medicine is prescribed and take too much or too little. Undertaking pain medication can lead to cardiovascular problems and poor healing of the wound, in addition to increased pain, De Oliveira said. Seniors’ low health literacy is not necessarily related to education level or socio-economic status, he noted.

Better Discharge Planning Required

The solution is to design clearer discharge instructions tailored to seniors, De Oliveira said. “Before allowing patients to get ambulatory surgery, surgeons also should verify if patients are able to take care of themselves at home, and if they have support,” De Oliveira said. “If not, patients should be admitted to the hospital after surgery or have some type of formal support by a nurse to help them at home.” The likely cause, based on previous research, is difficulty understanding medication dosing and discharge instructions, as well as cognitive impairment among older patients.

The study found age is an independent risk factor for ambulatory surgical complications, which was not previously known.