Patient re-admissions are becoming revolving doors for Addiction Treatment Programs.
One of the continuing problems with the quality of Substance Abuse treatment services has been the governments’ growing concern over the high numbers of patients failing to complete residential treatment. Many times these same patients turn around only to be re-admitted for care within 90 days for the same diagnosis.
Even in cases where patients are discharged from services as “treatment complete”, they are often left with fragmented treatment plans. Many of these follow-up care problems include infrequent referrals to After Care services, linkages to AA Sponsors, basic networking to jobs, Sober Living arrangements, poor communications with Aftercare case managers. These same programs are sited on CARF surveys for clinical program failures.
One contributing factor, are these programs data collection systems. We’ve found a continuing lack of accounting for the numbers of patients leaving treatment early, only to be re-admitted for addictions services somewhere else in the public delivery system. This current pattern of revolving door expenditures of public monies, serving the same people repeatedly must be replaced by Performance Based Contracting. Implementation of performance based contracting process would require treatment programs to document successful, patient outcomes linked to their Statewide Performance Standards.
What is interesting is that Behavioral Health research data suggests the best timing for aftercare coordination should be started at the time of Admission. Studies have clearly shown, “re-admission rates can be reduced through coordinated discharge planning, education of patients and families about how to best handle their chronic medical conditions. Close follow-up by a counselor or peer counselor can benefit the patient after discharge. Programs simply do not have a clear perspective of the problems leading to patient re-admissions.
This research is part of a Robert Wood Foundation Report on U.S. Hospital Admissions where they found that “Information about a patient does not always travel with the individual back to their home community, resulting in tenuous accountability scattered among community physicians, referral agencies and families.”
Klees BS, Wolfe CJ and Curtis CA. Brief Summaries of Medicare and Medicaid: Title XIX of the Social Security Act as of November 1,2010. Baltimore, MD. Office of the Actuary at the Centers for Medicare & Medicaid Service, 2010, www.cms.pov/MedicareProQramRatesStats/downloads/ MedicareMedicoidSummeries2010.pdf
Jencks SF, Williams MVand Coleman EA. “Re-hospitalizations among Patients in the Medicare Fee-For-Service Program.” New England Journal of Medicine, 360(14): 1418-1428, 2009.
Carlos T. Jackson, Troy K. Trygstad, Darren A. DeWalt and C. Annette DuBard.” Transitional Care Cut
Hospital Readmissions for North Carolina Medicaid Patients with Complex diagnoses.
Chronic Conditions”. Health Affairs, 32, no.8 (2013) 1407-1415.
Addictions Consulting group
The Addictions Consulting Group (ACG) is a premier national consulting firm specializing in helping people, teams, and organizations achieve maximum program effectiveness. We provide an expert staff of senior practitioners, and we offer our clients exceptional experience, diversified insight, written CARF policies, including a full range of services. ACG’s Team offers assistance with writing CARF for your program: including: CARF Planning manuals, strategic Organization Plans, coaching, training, and quality outcome reports and Electronic Health Records software.
In today’s climate of scarce resources for behavioral health programs, only those programs that can credibly demonstrate their cost-effectiveness and outcome reliability will garner the funding necessary to sustain and expand their efforts.
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