HealthLawProf Blog

Editor: Katharine Van Tassel
Akron Univ. School of Law

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Tuesday, October 9, 2012

Shooting an Elephant With a BB Gun and the Problem of Hospital Readmissions

Modern Healthcare (subscription publication) recently featured a story about how some hospitals are trying to reduce hospital readmissions by getting into the housing business.  Both Medicare and Medicaid are beginning to penalize hospitals financially for readmissions of patients that were recently discharged.  But it appears that the problem for many people that lands them back in the hospital after discharge is not poor quality of care in the first hospital stay, or inappropriate discharge, but homelessness.  So hospitals are taking on the project of finding housing for homeless patients, in the hope that doing so will reduce readmissions, lower hospital costs, and prevent hospitals from incurring financial penalties.

Early results of these projects are promising.  In New York City, where the lack of available hosing for low-income, medically fragile people is particularly acute, a pilot program run by the health department which paired such patients with care coordination, social services, and housing, resulted in a drop in hospitalizations by 47% and a reduction of 50% in emergency room visits.  Spending for hospital care fell by 27%, and emergency room spending by 30%.  Similar projects in Minneapolis and San Francisco are also underway.

Dr. Josh Bamberger, the medical director for Housing and Urban Health at the San Francisco Department of Health, is a firm believer in a strong connection between stable housing and managing medical problems.  He says "I think that providing healthcare for the homeless without housing is like shooting an elephant with a BB gun."

These efforts by hospitals and health care systems to address the problems of hospital recidivism through social interventions point out that reducing costs in the health-care system will not happen if we merely penalize the providers who are treating the symptoms of poverty, mental illness, substance abuse, and homelessness, and blame them for health-care outcomes that come about because of problems outside of their control.  High health-care costs are not solely the result of failure to take personal responsibility for one's health, nor are they solely the result of greed and waste in the system or poor quality care. They are the result of complex and pervasive problems with no easy solution.

The legal community has  recognized this over the past ten years, and is addressing it through the use of medical-legal partnerships.  In these partnerships, a lawyer is placed at a hospital or community health center that treats low-income people, and is trained to work with patients on the problems of poverty that cause poor health outcomes.  It now appears that hospitals and health-care systems are embracing this holistic approach as well.  Tracking the results of these projects, both for health-care outcomes and for costs, should yield useful data regarding how to reform our health-care system so that we get what we pay for.

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