Hospital Readmission Rates Stagnant
By Mary Ellen Schneider
Elsevier Global Medical News
Many hospitals may be unprepared for a new Medicare requirement to lower readmissions, and could face resulting financial penalties over the next few years, according to a new report from the Dartmouth Atlas Project.
Over a 5-year period, hospitals made little progress in reducing readmissions among Medicare beneficiaries aged 65 years and older. The Dartmouth Atlas researchers found that surgical 30-day readmission rates were 12.7 percent in both 2004 and 2009, and medical 30-day readmission rates rose from 15.9 percent in 2004 to 16.1 percent in 2009.
They found similar trends when they looked at specific conditions. For example, the national readmission rates for hip fractures were 14.3 percent in 2004, compared with 14.5 percent in 2009. The rates were also relatively unchanged for congestive heart failure (20.9 percent vs. 21.2 percent) and pneumonia (15.1 percent vs. 15.3 percent). However, U.S. hospitals showed some improvement in acute myocardial infarctions, reducing 30-day readmissions from 19.4 percent in 2004 to 18.5 percent in 2009.
“For a long-standing and well-recognized problem, not much progress has been made,” Dr. David C. Goodman, the study’s lead author and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, said during a press conference to release the findings.
The researchers analyzed data for fee-for-service Medicare beneficiaries aged 65 years and older who lived in 306 Dartmouth Atlas hospital referral regions and had both Part A and Part B Medicare coverage.
Hospital readmissions have garnered significant attention in the health care community since the passage of the Affordable Care Act. The new health law calls on the Centers for Medicare and Medicaid Services to start measuring 30-day hospital readmission rates and to penalize poor performers. In October 2012, hospitals with high readmission rates will face penalties of 1 percent of their total Medicare billings. The penalty increases to 2 percent the following year.
Part of the solution to reducing hospital readmissions is good discharge planning, Dr. Goodman said. “This sounds simple but often doesn’t happen.”
That planning should include having the care team in the hospital develop a care plan and communicate that plan to the patient and their family. It also means ensuring that the patient has all the necessary prescriptions, understands what medications to take and when, and can get their prescriptions. And health care providers in the hospital should also help patients set up follow-up appointments with their primary care physician, Dr. Goodman said.
But aside from discharge planning, there are also “hidden” factors such as how local patterns of hospital use affect readmission rates. Dr. Goodman and his colleagues found that communities and health care systems with higher underlying admission rates also tended to have higher rates of hospital readmission.
“This data really speaks to how difficult it is to tackle the problem of readmissions. In the time period the report covers there has been a lot of effort made to try to address this problem, but it hasn’t been sufficient. It doesn’t mean that all the efforts have been a waste, but obviously it’s not enough. If this were easy, we’d have fixed it by now,” said Dr. Jeffrey Greenwald, a hospitalist at Massachusetts General Hospital in Boston.
“With the Affordable Care Act there will be a greater opportunity to take some of the lessons learned from the key initiatives around care transitions and operationalize them. But it’s only going to happen once the Affordable Care Act or some version of bundled payments begins to align incentives around care coordination and transitional care,” according to Dr. Greenwald, who is also a co-investigator for Project BOOST (Better Outcomes for Older Adults through Safe Transitions), a quality improvement project from the Society of Hospital Medicine, which is aimed at improving the hospital discharge process and reducing readmissions.
The Dartmouth Atlas Project receives most of its funding from the Robert Wood Johnson Foundation, the National Institute on Aging, the California Healthcare Foundation, the United Healthcare Foundation, and the WellPoint Foundation. The researchers reported no financial conflicts.
Online October 13, 2011