Op-Ed: Is Nutrition the First Step in Addressing Hospital Readmissions?

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How do we reduce readmissions in a way that is both effective and efficient for hospitals? The first step could be as simple as education, screening and nutrition intervention.

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Hospital readmissions of Medicare patients aged 65 and over is a health concern impacting patients, families and hospitals across the U.S. According to the Centers for Medicare and Medicaid Services, the issue also costs U.S. taxpayers more than $17 billion in additional hospital bills. A fresh look at how nutrition is being prescribed in the hospital may yield a simple solution, leading to both decreased hospital costs and improved patient care.

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According to the Robert Wood Johnson Foundation, one in eight Medicare patients were readmitted to the hospital within 30 days of being released after surgery in 2010, while one in six patients returned to the hospital within a month after receiving medical care. As U.S. News reported recently, hunger and the lack of proper nutrition among our nation’s seniors has contributed to an increase in hospital readmission rates among this population causing poorer outcomes for patients and putting undue burden on hospitals and treatment centers.

And it is not just Medicare patients that suffer from lack of nutrition. As U.S. News pointed out, a University of San Francisco study found that for low-income patients with diabetes, hospital admission for hypoglycemia increased 27 percent in the last week of the month versus the first week. The study concluded that one of the reasons for this timing was based on when these patients received their paycheck and/or food stamps.

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In order to create an incentive for hospitals to reduce these readmission rates, the Affordable Care Act (ACA) began penalizing hospitals whose readmission rates were too high as of October 2012, and this penalty was increased this past October. Federal data estimated that more than 2,000 hospitals – mostly in underserved areas – will be penalized more than $280 million in Medicare funding in 2014. Hospitals in Illinois, New Jersey, the District of Columbia and Massachusetts will be most affected as these states and the District have the highest readmission rates.

How do we reduce readmissions in a way that is both effective and efficient for hospitals? Many hospitals are trying various forms of aggressive in-hospital tracking and follow up after the patient’s discharge – including more focused and intensive efforts at discharge planning, programs to follow up on test results and increasing outpatient services. But the first step could be as simple as education, screening and nutrition intervention.

In 2013, the Alliance to Advance Patient Nutrition published a consensus report, “Critical Role of Nutrition in Improving Quality of Care,” which proposes a model to improve patients’ quality of care, including at discharge. In the report, the Alliance, comprised of leaders from the Academy of Medical-Surgical Nurses, the Academy of Nutrition and Dietetics, and the Society of Hospital Medicine, issued a call to action for health care providers and hospitals to update the current clinical practices to include more rigorous nutrition screening for patients and timely nutrition intervention standards for patients at risk of malnourishment.

Addressing nutrition issues may benefit hospitals as well as patients. By providing appropriate oral nutritional supplements -- medical nutrition that provides a balance of calories, protein and other nutrients, often in liquid form -- to seniors in the hospital, it may be possible to improve quality of care and reduce readmissions in an immediate and cost-effective way.

A recent retrospective health economic study, conducted by researchers at University of Southern California, Stanford University, The Harris School at The University of Chicago and Precision Health Economics, found that providing oral nutritional supplements to Medicare patients helped reduce key outcomes, such as 30-day hospital readmission rates and length of hospital stays, for three of the most common ailments associated with readmissions for Medicare patients aged 65 and over-- myocardial infarction (i.e. heart attacks), congestive heart failure and pneumonia.

The research, which was supported by Abbott and presented at the Society for Medical Decision Making (SMDM) annual meeting in October 2013, also showed that nutritional supplements offered to all Medicare patients aged 65 and older with any primary diagnosis were associated with a 16 percent reduction in length of stay and a 15.8 percent cost savings – an average of $3,079 -- per episode.

As our healthcare system continues to face a growing Medicare population and rising costs, something as simple as empowering hospitals and all healthcare practitioners to screen and identify the nutritional status of their patients and educate them on the importance of nutrition, can go a long way in reducing costly health care problems.

Additional work is needed with collaboration by multiple stakeholders including hospitals, health care leaders, academics, industry and policymakers to tap the true potential of nutrition in hospitals. As health care systems look for ways to improve the quality of care for Medicare patients, we need to implement simple, cost-effective solutions and act immediately to educate, screen and implement nutrition intervention.

Robert H. Miller, Ph.D., is the Head of Global Research and Development, Scientific and Medical Affairs for Abbott Nutrition.

health care
health care reform
senior health