"We are talking about really sick patients," Flanders said. "There is a lot of frustration with this. The process is out of our control. We can't lower readmission rate where we do not suffer penalties."
Medical chart reviews often show that patients most often readmitted within 30 days have similar problems. For example, most patients fail to make appointments with their physician after discharge or do not understand or remember what they are supposed to do after they are discharged.
Moreover, hospitals that never treated certain patients sometimes must readmit those patients for either one of the three original conditions or for an entirely new medical problem. When hospitals do readmit a patient within 30 days, for whatever reason, Medicare considers that a failure and hospitals lose revenue.
"We have found there is not a direct cause and effect to why patients are readmitted," Flanders said.
For example, Flanders said he recently conducted medical chart reviews of patients being readmitted in Beaumont Royal Oak's emergency department.
"I found they are really sick people who had medical issues that needed to be taken care of in the hospital," he said. "There was no lack of coordination after (original) discharge."
As a result, Flanders said, Beaumont will lose $2.9 million in Medicare reimbursement for readmitted patients from Oct. 1, 2012, to Sept. 30, 2013.
Despite studies and projects to coordinate care among home health agencies, nursing homes and physicians, Flanders said "nobody has found the magic bullet for this."
Medical professionals initially thought the use of telemedicine and home medical monitoring devices like blood pressure cuffs and wireless weight scales showed early promise, Flanders said.
"We looked at the data and there was no improvement in readmission rates for patients using telemedicine versus those who didn't get it," Flanders said.
Now, Beaumont, Henry Ford and other hospitals and home health agencies are experimenting with systems to identify patients who are at higher risks for readmission.
Greg Solecki, vice president of home health with Henry Ford at Home, said working with recently discharged patients referred to home health services helps to coordinate care to avoid readmissions.
"We are all moving in the same direction, but there are so many variables when they go home we have to take them all into account," Solecki said. "We are developing report cards of patients at skilled nursing facilities with high-risk for readmissions. We think this will help."
For example, Beaumont is using the "LACE" system to track high-risk patients. LACE is an acronym that takes into account length of stays the patient previously had before discharge, the acuity, or sickness, of a patient at admission, the comorbidity (multiple health problems) and the number of emergency visits the last six months.
Flanders said Beaumont has done all the recommended checks after discharge, including making sure patients contact their physician for appointments one week or less after discharge and make sure they have all their medications.
"Right now we are planning for budget losses," Flanders said. "It will be quite some time" before hospitals improve enough to avoid penalties.