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Health Care / HEALTH CARE

Hospitals Flunk Readmission Test

Hospitals are not improving readmission rates, the Dartmouth Atlas Project finds.(Courtesy of Fairfax Inova Hospital)

photo of Maggie Fox
September 27, 2011

Hospitals are about to get punished for so-called readmissions – when patients end up right back in the hospital after being discharged. Yet they’ve done very little to improve, researchers reported on Wednesday.

Hospital readmissions are considered an important measure of quality care. Health experts say it’s important to hold hospitals accountable for how well patients fare after they are discharged. The 2010 health care law hopes to force hospitals to take better care of patients and make sure someone keeps an eye on them after they are treated for a serious illness or have surgery.

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Dr. David Goodman of the Dartmouth Atlas Project says his most recent data shows little or no improvement. “Probably the most important finding is for this long-standing and well-recognized problem, not much progress has been made,” Goodman told reporters in a telephone briefing.

His team followed six groups of Medicare patients with a broken hip, pneumonia and other common conditions to see how they fared after a hospital stay. Ideally, after patients are in the hospital, they should see their regular doctors within two weeks and someone should make sure they are taking prescribed medicines as directed. If they end up back in the hospital in 30 days or less, it’s usually a signal that something went wrong.

Teaching hospitals should have a good record of improvement but the Dartmouth team found large variations, with little sign of progress.

“Only seven of the 94 academic medical centers we studied had statistically significant changes in 30-day readmission rates following medical discharge from 2004 to 2009,” Goodman’s team wrote.

“Following surgical discharge, at least 20 percent of patients were readmitted within 30 days at two academic medical centers: Hahnemann University Hospital in Philadelphia (20.6 percent) and Ohio State University Medical Center in Columbus (20.1 percent),” the report reads.

“At least 20 percent of patients were readmitted within 30 days of medical discharge at 13 academic medical centers, including the University of Medicine and Dentistry of New Jersey Hospital in Newark (22.3 percent) and the University of Minnesota Medical Center in Minneapolis (22.2 percent).”

Few hospitals had any change in these readmission rates from 2004 to 2009, Goodman’s team found. Their project gathers data on individual hospitals and can compare one region, city or town to others. “There were a few that showed some improvement but generally, at least during this time period, this is really a static problem,” he said. “Although there was variation, certainly, by region…there is no place that stands out as having exceptionally low readmission rates at this time.”

The percent of patients landing back in the emergency room within 30 days of discharge after surgery varied from less than 12 percent in 2009 in Rapid City, South Dakota, to 19 percent in Kingsport, Tennessee and 18 percent in Newport, Rhode Island

In 2009, a team at Northwestern University found one in five Medicare patients were re-admitted within 30 days in 2003 and 2004. The Medicare Payment Advisory Commission (MedPAC), an independent agency that advises Congress, estimated that in 2005 readmissions cost Medicare $15 billion.

The 2010 health-care reform law begins using a stick in one year, penalizing hospitals with higher-than-expected readmission rates for Medicare patients treated for heart failure, heart attack or pneumonia. Medicare payments could be cut  by up to 1 percent in October 2012, 2 percent in 2013 and 3 percent in 2014.

Goodman said patients have a right to expect to feel better when they check out of the hospital.

“Often times, hospitals have seen their responsibility as ending when they see the patient leave the door and made minimal effort when it comes to coordinating care or communicating with community physicians,” he said.

Hospitals know what they are supposed to do – contact a patient’s personal doctor, or nursing home, and make sure the patient has a follow-up visit. “Fewer than half of patients saw a primary care physician within 14 days of leaving the hospital,” Goodman said. Some hospitals have nurses on staff to follow up but the U.S. health care system mostly relies on doctor visits.

“In all places, they fall short of what we would expect,” Goodman said. “Emergency rooms are too often the place where patients end up being seen. “Obviously, many of those ER visits are the portal of entry back into the hospitals of readmission.”

Hospitals can do much more to take a team approach and make sure all the doctors, nurses and other experts who see a patient plan for the discharge and coordinate care and follow-up, Goodman said.

“This sounds simple but often it doesn’t happen in all of the activity and busyness of a hospital,” he said. And hospitals must recruit family members to help, he added.

Some hospitals do truly have a patient population that is sicker and poorer than average, Goodman said, and they will expect to see those patients back more often. “Be that as it may, hospitals are the most powerful and largest health care entity in any market in the United States and can have a tremendous influence if there’s a will in terms of improving and coordinating care,” he said.


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