 | Regional Intensity of Care is Strongly Related to Risk of Readmission, Regardless of Illness Level |
| (Lenox Hill Hospital, 77th St. : By Daniel Case, Wikimedia Commons) |
The Takeaway
1. A nationwide survey of Medicare patients found that one in six medical discharges and one in eight surgical discharges resulted in a return to the hospital within 30 days.
2. Surgical patients released in areas with some of the the highest readmission rates [Manhattan (16%); White Plains (17.4%); and the Bronx, NY (18.3%)] were almost twice as likely to be readmitted as those in areas with the lowest rates [Bend, OR (7.6%); Boise, ID (8.4%); and Spokane, WA (9.5%)].
3. Avoidable readmissions were most likely to occur in regions where hospitals had the highest utilization rates.
4. Avoidable readmissions cost the government 17 billion dollars annually.
The One Minute Summary
Released on February 13, by the Robert Wood Johnson Foundation, and presented in an interactive map form by the Dartmouth Atlas Project, this study highlights the nation's lack of progress in addressing hospital readmissions. The authors looked at readmisison rates between 2008 and 2010 for states, hospital referral regions (HHRs) and 3000 individual hospitals. They sorted the population into two cohorts : those hospitalized with either surgicalproblems or medical problems. Three types of medical patients were also examined: those diagnosed with Pneumonia, Myocardial infarction or Congestive Heart Failure. Results were adjusted for age, sex, race and chronic illness mix. The report also included interviews with Medicare patients, nurses, family members and physicians.
Overall, the study found that there were no significant declines in 30-day readmission rates in any region of the country. The 2010 readmission rates were roughly the same as they had been in 2004 when the Dartmouth Atlas Project first started looking at the issue. The most important factor driving readmission rates was the local pattern of hospital utilization. Patients were more likely to return to in-patient care in regions where hospitals served as the main site of care. Patients were also likely to be readmitted due to illness level, the lack of availability of post-hospital care, and medication problems. A major stumbling block has been a lack of clarity about who should coordinate patient care following discharge. There is often poor communication between the discharge team, community physicians and non-acute care facilities.
This is disappointing news for many institutions. Since passage of the Patient Protection and Affordable Care Act hospitals have been under pressure to reduce readmision rates. The Centers for Medicare and Medicaid are now authorized to lower reimbursements to hospitals whose rates are higher than expected. In 2012 over 2000 US hospitals had their Medicaid payments lowered by 1 percent. Even higher penalties will be imposed this year unless hospitals can turn this around.
Read the Report: THE REVOLVING DOOR: A REPORT ON U.S. HOSPITAL READMISSIONS
