Policy Options to Improve Discharge Planning and Reduce Rehospitalization

Short hospital stays, rehospitalizations and transitions among health care settings have become increasingly common. Financial policy changes should be implemented to incentivize longer hospital stays and better-coordinated post-discharge care.

Hospital discharge is complex for many reasons, including the variety of postacute care options, the strictness of discharge deadlines, the involvement of multiple specialists and the limited involvement of primary care physicians. The authors argue that without penalties or financial incentives, hospitals have little reason to make hospitalizations longer or to avoid rehospitalizing patients.

Recent policy changes, however, have attempted to create such incentives. Accountable Care Organizations (ACOs), made up of hospitals, physician groups and other health care organizations, have formed to increase clinical accountability for patients’ transitions among health care settings, while policies bundling Medicare acute and postacute payments disincentivize multiple hospitalizations. The Affordable Care Act also aims to reduce rehospitalizations, while the Centers for Medicare and Medicaid plan to penalize health organizations whose patients are too often rehospitalized.

The authors point out that each health care system will have different resources and, therefore, recommend that individual systems use available tools, such as ACOs or payment-bundling options, to begin determining how best to help their own patients navigate health care setting transitions.