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HOSPITAL READMISSIONS BACKGROUND

Preventable hospital readmissions are a significant avoidable cost in the U.S. health care system, costing an estimated $25 to 26b billion annually. The principal reasons cited for most hospital readmissions is poor discharge procedures and inadequate follow-up care, with a bulk of the responsibility as to cause of the readmission falling on the side of the hospitals. Hospitals pay annual fines in relation to their total annual readmission rates, which leaves the secondary cost of readmissions to be paid with tax payer money by Medicare and Medicaid or through Private Insurers, which raise their rates to cover the unforeseen readmissions cost they incur.  

The .J Am Coll Surg. Hospital readmission study identifies any readmission within 30-days of an index hospitalization as a marker of poor quality patient care. The study identifies factors associated with 30-day readmission following General Surgery procedures. This is an indication of the general risk any local Public hospital undertakes simply by treating their patients ailments.

Hospitals abide by The Emergency Medical Treatment and Labor Act (EMTALA) which is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Hospitals by nature help the sick and injured and don’t pick and choose their patient’s ailments and as a function of their service act and react to their patients needs on a case by case basis. This same concept applies when looking at the problem of readmissions and their root causes. There are a number of known causes that generally result in a patients need for readmission, but in addition to the root causes there are countless elements that factor into a patients  potential for readmission with a split between factors that increase and factors that decrease a procedures risk for readmission into the hospital.

Although readmissions is often seen as a lapse or failure by the hospital, there are a large number factors that are beyond a hospitals control including varied populous, age and health demographics, socio economic breakup, environmental, pre and post care and countless other factors that specifically correlate to an individual’s health following a stay in the hospital. There is even a distinction between factors that play a role in readmission specific to an individual’s health care plan and provider.          

With such a wide range of factors that contribute to the potential for readmission we see most of the negative aspects associated with the costs and fines related to a patient’s readmission falling on hospitals, which pass the cost on to insurers and ultimatelyto tax payers and consumers.  

This concept contemplates a new and innovative means of readmissions monitoring, validation, protection and cost reduction for hospitals and insurers through the creation of a “Readmissions Risk Ratio Quotient” that is the backbone of an innovative patent pending product called “Readmissions Insurance”