On the face of it, this is not a bad idea. It creates a disincentive for patients to be sent home before they're entirely stable, and also creates an incentive for hospital-based systems to co-ordinate follow-up care.
However, this penalty does not recognize that in many cases the causes of re-admission may be economic and not medical. For example, patients may not be able to afford new medications, co-payments for follow-up visits, or may not have reliable transportation. Additionally, it puts hospitals that admit a lot of poor or elderly patients at higher risk due to the complexity of medical conditions that they treat, and the additional economic and logistical problems their patients may have.
As one healthcare policy expert put it, we’re using a proxy because it’s a convenient proxy — it’s just not a very accurate proxy.
For my own part, I think 30 days after going home is an unreasonably long duration of time. A lot can happen in a month after going home that may be unfortunate, but is no fault of the doctors or the hospital.
This article also talks about the elephant in the room, which is patient responsibility. Is it really reasonable to expect hospitals to make appointments for patients, or to arrange transport or pharmacy deliveries? At what point does the patient become responsible for being pro-active in their own health?
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