Re-admission Issues: A Revolving Door for Addictions Treatment
One of the continuing problems with the quality of Substance Abuse treatment services in rural states has been the growing concerns over the high numbers of patients failing to complete residential treatment.
Many times these same patients turn around only to be re-admitted for care within 90 days for the same diagnosis. Even in cases where patients are discharged from services as “treatment complete” they are often left with fragmented follow-up aftercare, which includes problems such as infrequent referrals to After Care services, linkages to AA Sponsors, basic networking to jobs, sober living arrangements combined with poor or even no communications with the referring treatment program.
Research has clearly shown of the “nine million hospitalizations of Medicare Patients per year’, five million, some 20.0% or almost one in five patients are readmitted within a month of discharge with many more returning to the emergency room”.[1] According to the Robert Wood Johnson Foundation, “many of these re-admissions are caused by inadequate discharge planning, poor care coordination between facilities and clinicians and the lack of longitudinal community based care.” There’s little question that the high numbers of patients leaving early against medical advice from publicly funded Residential Addiction Treatment Programs plays into the problem of expensive patient re-admissions.
One major flaw in rural states data collection systems is a continuing lack of accounting for the numbers of patients leaving treatment early only to be re-admitted for addictions services somewhere else in the public delivery system. This current pattern of revolving door in expenditures of public monies serving the same people repeatedly should be considered for replacement by a performance based contracting process. However, the implementation of a performance based contracting process would require treatment programs to document successful, patient outcomes linked to national standards of quality improvement.
What is particularly interesting is that current hospital research data suggests the best timing for aftercare coordination should be started even before the patient is fully ready for discharge, since they and their families may not fully comprehend their roles in successfully overcoming addictions. Studies have clearly shown, “re-admission rates can be reduced through coordinated discharge planning, education of patients and families about how to handle their chronic medical conditions, and by close follow-up by a nurse after the patient is discharged from treatment.”[2]
Programs for the most part simply do not have a clear perspective of the quality control problems leading to patient re-admissions. In talking with patients over the years we have found that many of those people in treatment simply do not have a clear understanding of the medicines they’re taking, their treatment plans or continuing care plans upon discharge from residential services.
A Robert Wood Johnson Foundation Report on U.S. Hospital Admissions indicates, “Information about a patient does not always travel with them back to their home community.” This major problem often results in a tenuous accountability scattered among treatment programs, community physicians, referral agencies and families.”[3]
The Affordable Care Act directs the Center for Medicaid / Medicare Services (CMS) to develop Community based Care Transition Programs (CCTP) and provides funding to test Models for improving care to high risk patients.
[1] Klees BS, Wolfe CJ and Curtis CA. Brief Summaries of Medicare and Medicaid: Title XIX of the Social Security Act as of November 1, 2010. Baltimore, MD. Office of the Actuary at the Centers for Medicare & Medicaid Service, 2010, www.cms.pov/MedicareProQramRatesStats/downloads/MedicareMedicoidSummories2010.pdf
[2] Jencks SF, Williams MV and Coleman EA. “Re-hospitalizations among Patients in the Medicare Fee-For -Service Program.” New England Journal of Medicine, 360(14): 1418-1428, 2009.
[3] Carlos T. Jackson, Troy K. Trygstad, Darren A. DeWalt and C. Annette DuBard:” Transitional Care Cut Hospital Readmissions for North Carolina Medicaid Patients with Complex Chronic Conditions”. Health Affairs, 32, no.8 (2013)1407-1415. http://content.healthaffairs.Org/content/32/8/1407.full.html
