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Toni Talks about PT Today

Comeback Stories

Published September 17, 2013 5:46 PM by Toni Patt

"Frequent flyer" is a term given to any patient with serial admissions to a facility. They discharge. They admit. They discharge. They admit. Eventually everyone on the staff will have worked with the patient. Some are remembered fondly. Some never see the same therapist twice. Sometimes the multiple admissions are due to progressive disease processes and medical management. Sometimes medical non-compliance is the cause.

I've noticed some things about our frequent fliers lately. They're coming back more often. The duration between admissions is getting short. With one or two exceptions, they're sicker when they come back than when they left. I'm not sure why this is happening.

Any time a patient discharges from a hospital and then bounces back within 30 days is a ding for the hospital. Any time a SNF sends a patient back within the same 30 days, it's a ding on them. If this happens enough times, there has to be some kind of blow back on the facilities. Frequent readmissions also deplete Medicare days and insurance funds.

At the same time, I'm seeing new trends. Patients are being discharged quicker than ever. They're also sicker than ever before. Remember that illness severity doesn't correspond to being medically stable. Medically stable patients can be discharged no matter how sick they are. Those same patients are telling me with increasing regularity that they aren't receiving any therapy while in acute-care hospitals. Maybe a third of them haven't been out of bed since admission when I'm doing my assessment.

I think it's safe to say without presenting supporting research that getting patients out of bed helps them improve. And the sooner they get up, the better. We also know that acute therapy staffs are stretched very thin. I would love to see a longitudinal study looking at the correlation between therapy staffing, early mobilization, outcomes and readmissions.

Left unsaid here is the influence of continued cuts in reimbursement. I'm sure someone is looking at these numbers. Nonetheless, healthcare is profit-driven. If getting patients discharged as fast as possible saves money, the practice will continue until frequent readmissions cost them more.

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You've summed it up perfectly! Institutions looking at short term costs and completely forgetting about the long haul, and patients!

The hospital passes the buck to the SNF, both pass the buck to home health, and home health passes it back to the PCP and family in the name of "personal responsibility".

Healthcare facilities need to start owning the outcomes of their patients again. I believe that is the whole point behind the 30 day bounce back ding.

Dean Metz September 18, 2013 7:24 AM

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