Health Insurer Has Good Idea!

Dan Frith

Contributor

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We all have heard stories, maybe even experienced the problem first hand, of hospital patients discharged from the hospital before their health and condition would warrant a discharge. Why? Because their health insurance company has arbitrarily decided that the average patient with similar conditions needs to be discharged. Don't want to run up that hospital bill! It's all about the money! Well...now money may be driving health insurers to let patients who need hospitalization stay in the hospital and if discharged, provided with the type of supportive medical care they need while at home.

According to the Medicare Payment Advisory Commission, 18% of Medicare patients admitted to a hospital are readmitted within 30 days of discharge....accounting for $16 billion in spending. In response, the Institute for Healthcare Improvement (IHI), a non-profit organization in Boston, has called for the establishment of "transitional care programs." These programs would follow discharged patients' medical conditions for varying periods of time at their home. The IHI is working with hospitals to reduce readmissions by:

o Identifying patients at risk for readmission
o Scheduling patient follow up doctors' appointments before they are discharged
o Sending nurses to the patients' homes
o Monitoring patients at home
o Educating patients on important warning symptoms and self-care regimens

Aetna, one of the largest health insurers in America, and Kaiser Permanente, are working to establish pilot programs to determine the feasibility of this program. Sometime good things come out of corporate America's pursuit of the almighty dollar!