Case Management in Healthcare and the Readmissions Epidemic: What Can Be Done?

By Jeremy Brooker

Three years ago, the Obama administration passed the Patient Protection and Affordable Care Act. As part of its overhaul of the United States’ healthcare system, the act penalizes hospitals for higher-than-expected readmission rates in an effort to force improvements in hospital quality. Though readmissions - defined as a patient being admitted back into the hospital within 30 days for the same diagnosis - are certainly not a desirable thing, many argue that the new government initiatives seek to mandate and penalize without providing viable solutions. Michael Demoratz, PhD and Certified Case Manager, says this is an issue case managers in hospitals face on an almost daily basis. As a whole, the readmission problem stems largely from the woes of aging patients.  

“A lot of times, elderly patients end up back in the hospital or emergency room simply because they don’t know what to do, or because they have nowhere else to go,” said Demoratz. He explained the typical scenario where a patient is discharged in the afternoon and gets home a few minutes after 5 p.m. “If that patient has an issue or concern for the doctor and his office is closed when they call, they may dial 911 - or end up back in the hospital some other way when they don’t necessarily need to be.”

The rising senior population, caused by the aging of the Baby Boomer generation, has intensified the issue. Given that there are more seniors in the US now than there have ever been (and that the senior population is expected to more than double over the next forty years), this readmission problem is certainly not something that will just go away.

“Case managers are looking for ways to reduce this kind of thing,” said Michael, “and to do so in a way that still provides support and a plan of care for their elderly patients.”

“One way to do this,” Michael noted, “is in-home senior care.”

As a former case manager, Michael noted that he and many of his colleagues would leverage crucial relationships with senior care providers to manage and monitor patients outside the hospital.

“Caregivers are trained in helping seniors perform various activities of daily living –things like bathing, dressing, medication reminders, feeding, ambulating, and the like,” Michael said. “Assistance with things like this, sensitivity to how to handle patients with certain conditions, and an awareness of warning signs that come from various conditions – these are things that caregivers provide that are hugely useful to case managers in reducing readmissions.”

Michael’s assertions are independently verified: a 2013 academic study by The Commonwealth Fund showed that case managers’ utilization of in-home senior care services reduced readmissions for elderly patients with heart failure by a whopping 46%. For dually eligible Medicare and Medicaid patients with special needs, readmissions were reduced by 21%.

Michael said a collaborative effort among physicians, case managers, senior care companies and their in-home caregivers can help improve the readmissions problem significantly.

“The resources for lessening readmissions are out there,” Michael said. “Case managers just need to make more use of them.”