Half of Medicare Patients Rehospitalized Without
Seeing Doctor After Discharge; 20% Return in 30 Days
Total cost of unplanned hospital readmission
exceeds $17 billion annually, vary widely across states
April 1, 2009 - One of five Medicare beneficiaries
discharged from the hospital is readmitted within 30 days, and half of
non-surgical patients are readmitted to the hospital without having seen
an outpatient doctor in follow-up, according to a Commonwealth
Fund-supported study in today’s New England Journal of Medicine.
All told, unplanned rehospitalizations cost
Medicare $17.4 billion in 2004, the study says. The study,
“Rehospitalizations Among Patients in the Medicare Fee-for-Service
Program,” by Stephen Jencks, M.D., M.P.H., Mark V. Williams, M.D., and
Eric A. Coleman, M.D., M.P.H., highlights the costs and health impact of
rehospitalization. It also details the key reasons for
rehospitalizations, and highlights gaps in patient management that may
be contributing to the high rates.
“Health care reform is front and center on the
national stage. As policymakers debate reform proposals, it’s important
for them to consider policies that will foster care integration and
coordination while encouraging hospitals to reduce readmissions,” said
Commonwealth Fund Assistant Vice President Anne-Marie Audet, M.D.
“Payment reform that provides the right incentives
for patient-centered care is a win for everyone. We can improve
patients’ lives and health, save our health care system billions of
dollars, and strengthen the primary care system.”
The researchers found wide variation in
rehospitalization rates among states. Between October 2003 and December
2004, the five states with the highest rehospitalization rates
(Maryland, New Jersey, Louisiana, Illinois, and Mississippi) had rates
45 percent higher than the five states with the lowest rates (Idaho,
Utah, Oregon, Colorado, and New Mexico).
They also found variation in the reasons for
rehospitalization. Most patients were rehospitalized for conditions
other than those for which they were originally hospitalized.
The rehospitalizations were so rapid that these
conditions should probably have been the focus of discharge planning in
many cases. Overall, 73 percent of patients who were initially in the
hospital for surgery were readmitted for medical diagnoses such as
pneumonia, heart failure, or bacterial infections.
The study also showed that a history of
rehospitalization and prolonged length of hospital stay were stronger
predictors of rehospitalization than age, gender, race, poverty, or
disability.
The authors suggest several steps to reduce
rehospitalizations including:
● interventions to better educate patients about
self-care in the hospital discharge process;
● helping hospitals better understand their
comparative performance on readmissions by providing them readmission
data for their patients including those who were rehospitalized
elsewhere;
● collaboration between physicians and hospitals
to ensure patients get follow-up care; and
● follow-up care from a primary care doctor as
well as a surgeon for surgery patients.
“You have to worry about a system in which
patients are rehospitalized soon after discharge with no bill for a
physician visit in between,” said Dr. Jencks.
“If we want to prevent unplanned rehospitalizations,
we have to help hospitals and community healthcare providers implement
transition procedures that are more patient-centered. Patients and
families should leave the hospital with a firm follow-up appointment and
knowing what to take, what to do, who to call if something unexpected
happens, and who they will see and when for follow-up.
“Doing less is unsafe because, as this study shows,
almost all of these patients are high risk—two-thirds will be
rehospitalized or die within a year of leaving the hospital.”
The Commonwealth Fund is a private foundation
supporting independent research on health policy reform and a high
performance health system.
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April 1, 2009 - One of five Medicare beneficiaries
discharged from the hospital is readmitted within 30 days, and half of
non-surgical patients are readmitted to the hospital without having seen
an outpatient doctor in follow-up, according to a Commonwealth
Fund-supported study in today’s New England Journal of Medicine.