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U.S. Hospitals Show Room for Improvement at Reducing Readmission Rates

A new report shows little progress has been made over a five-year period in reducing
hospital readmissions and improving care coordination for Medicare patients.

On the contrary, readmission rates for some conditions have increased nationally and for many regions and at hospitals, including some of America’s most elite academic medical centers, according to the Dartmouth Atlas Project. The report shows that roughly one in six Medicare patients wind up back in the hospital within a month after being discharged for a medical condition.

In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers found striking variation in 30-day readmission rates across regions and academic medical centers.

Researchers also found that more than half of Medicare patients discharged home do not see a primary care clinician within two weeks of leaving the hospital, and that facilities and regions with general patterns of high use of hospitals for medical conditions were frequently the same places with high readmission rates, an indication that some communities are more likely than others to rely on the hospital as a site of care across the board.

“The report highlights widespread and systematic failures in coordinating care for patients after they leave the hospital,” said Dr. David C. Goodman, lead author and co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. “Irrespective of the cause, unnecessary hospital readmissions lead to more tests and treatments, more time away from home and family, and higher health care costs.”

The readmission rate to a hospital is increasingly seen as a marker of a local health care system’s ability to coordinate care for patients across care settings, and readmissions are often a sign of inadequate discharge planning and the lack of effective community-based care. CMS has estimated the cost of avoidable readmissions at more than $17 billion a year.

In hopes of decreasing these costs, Medicare plans to reduce payments for readmissions, exposing hospitals to considerable financial risks. In fiscal year 2013, hospitals face a penalty equal to 1 percent of their total Medicare billings if an excessive number of patients are readmitted. The penalty rises to 2 percent in 2014 and 3 percent in 2015.

“The need to develop more efficient systems of care that include discharge planning and care coordination is clear,” said Dr. Elliott S. Fisher, report author and co-principal investigator of the Dartmouth Atlas Project and director of the Center for Population Health at the Dartmouth Institute for Health Care Policy and Clinical Practice.

“The report shows the opportunity for improvement, and the importance of aligning efforts to reduce readmissions with other policy and payment initiatives.”

Nationally, there was relatively little change in 30-day readmission rates from 2004 to 2009, regardless of the cause of the initial hospitalization. Readmission rates following surgery were 12.7 percent in both 2004 and 2009, while readmission rates for medical conditions rose slightly from 15.9 percent in 2004 to 16.1 percent in 2009.

Similarly, most regions across the country did not experience significant reductions in readmissions from 2004 to 2009.

In 2009, the percentage of patients readmitted to the hospital within 30 days of an initial discharge varied markedly for both medical and surgical discharges across regions of the country. Among patients who first visited the hospital for medical treatment, 16.1 percent were admitted to the hospital within 30 days.

Overall, 42.9 percent of patients who were released to go home from the hospital after medical treatment had a primary care visit within two weeks in 2009. Patients in New Orleans, La. were far less likely to see a primary care clinician after discharge home, with 25.6 percent having a visit to a primary care clinician within two weeks of medical treatment in a hospital, compared to 61.4 percent of patients in Lincoln, Neb.

Among academic medical centers, the range of variation was somewhat higher. Less than 20 percent of patients discharged from New York University Medical Center in Manhattan, N.Y. saw a primary care clinician within two weeks of a medical discharge, while the rate was nearly three times higher at the Mayo Clinic’s St. Mary’s Hospital in Rochester, Minn.

These findings highlight the pervasive problems with patient care after hospital discharge, and underscore the importance of primary care systems in reducing avoidable hospitalizations.

While there are many different reasons for higher readmission rates across regions and hospitals, prior research has documented the failings of current care coordination and the high proportion of readmissions that can be avoided by improving care.

“It’s very important that patients and health care providers communicate clearly so that all questions are answered and everyone understands what will happen when the patient leaves the hospital,” said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project. “Everyone – patients, doctors, nurses, caregivers – has a role to play in ensuring quality care and avoiding another hospital stay. They need to work together to create a plan for how care will proceed when the patient returns home. This should include a clear understanding of the patient’s medical problems, a schedule for follow-up appointments, a list of medications and instructions for taking them.”

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.




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