Check out of the hospital and stay out

  @Money November 5, 2012: 6:12 AM ET
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Hospital visits are costly. Reduce your chances of landing right back inside.

(Money Magazine)

Spending time in the hospital is bad enough. Worse, there's a decent chance you'll have to return for a second round shortly after departure.

According to a study in the New England Journal of Medicine, about 20% of Medicare beneficiaries are readmitted to the hospital within 30 days of discharge.

Common reasons for readmission include infection, medication errors, and confusion about your ongoing care plan.

"The majority of this is preventable," says Eric Coleman, co-author of the study and director of the care transitions program at the University of Colorado.

Besides being unpleasant, landing back in the hospital isn't cheap.

The average stay for re-hospitalized patients is 13% longer than for patients with the same condition who hadn't recently been hospitalized. Re-admissions account for 17% of Medicare's hospital payments (in October the agency began penalizing facilities deemed to have excessive rates).

Related: The painful new trend in Medicare

The Center for Studying Health System Change found that the average total bill for a readmission is $14,500. Hospital patients usually have to pay at least $500 to $1,000 out of pocket, says Coleman, but you could owe far more if you have a high-deductible plan or co-insurance that requires you to pay 20% to 30% of the tab.

The following tips can help you and your family members limit return trips.

Prevent errors

A recent study in Health Affairs found that patients are unintentionally injured in about a third of hospital stays, far more than previously thought.

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These events, often errors, increase your risk for both extended stays and readmission later on, says David Classen, a University of Utah professor and co-author of the study. Since medication issues are the most common problem, it's a good idea to ask nurses to say your full name and the drug name and dosage each time they hand over pills or insert an IV.

Get a companion for discharge

Patients are typically satisfied with their in-hospital care. It's the exit process that earns poor marks.

"We call it drive-by discharge," says Coleman. Before you walk out the door, you need to be clear on when it's okay to resume normal activity and what warning signs to look out for. Fever, redness, and confusion, for example, can indicate infection, which can lead to septic shock, a fatal condition.

Find out whom to call if you have questions or if symptoms develop, and ask the person who will serve as your primary caregiver at home to listen and take notes.

You'll also want to make sure the hospital doctor has the names and dosages of any medications you were taking at home and tells you if and when to resume taking them.

Related: Cut your health-care bills at any age

Some patients leave the hospital with a prescription for a generic drug, not realizing it's the same as the brand-name version they're already taking, says Nancy Foster, vice president for quality at the American Hospital Association. And some drugs, like blood thinners, require a follow-up test to make sure the dosage is correct.

Finally, inquire about home support. Medicare and insurers cover home care for some patients who need help with medical things like changing bandages and administering injections, but don't pay for home aides for routine activities such as bathing and dressing.

Some hospitals or insurers, however, have begun sending transition coaches to patients' homes to teach them and their family how to manage post-hospital self-care.

Follow up with your doctor

Though your hospital doctor is supposed to communicate with your primary-care doc, it doesn't always happen.

As soon as you leave the hospital, notify your primary-care physician and arrange for a follow-up appointment. About half of nonsurgical hospital patients readmitted within 30 days never followed up with their physician, according to the New England Journal of Medicine study.

Feeling healthier than Dr. Oz by the time your appointment date arrives? "Your physician may want to tweak what the hospital has prescribed," says Foster, "so go see the doctor anyway." To top of page



Most Common Causes of Injury
Harmful events occur in 33% of hospitalizations -- upping the length of stay and chance of readmission.
Medication-related 38%
Procedure-related 28%
Hospital-acquired infection 18%
Blood clot 4%
Note: Blood clot is pulmonary embolism/deep vein thrombosis. Source: Health Affairs, April 2011
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