More than one third of Medicare beneficiaries are readmitted to hospitals with first 90 days of being discharged, study finds
02 04 09 - 17:05
Study Finds Many on Medicare Return to Hospital
By REED ABELSON - The New York Times
The nation spends billions of dollars a year on patients’ return visits to the hospital — many of which are readmissions that could be prevented with better follow-up care, according to a study published Wednesday in the New England Journal of Medicine.
As many as a fifth of all Medicare patients are readmitted within a month of being discharged, according to the study, and a third are rehospitalized within 90 days.
Half the patients who returned to the hospital within 30 days of undergoing treatment other than surgery apparently did not see a doctor before they went back.
The high rate of hospital readmissions is “one of the fruits of an increasingly fragmented health care system,” said Dr. Stephen F. Jencks, a former Medicare official who is an author of the study, which analyzed Medicare claims information for 2003 and 2004. He estimated that the cost of the unplanned return trips was $17 billion in 2004 alone.
Policy analysts say that while high return rates have long been a problem, controlling those costs is increasingly urgent.
“Given the current financial situation, this is no longer something we can ignore,” said Dr. Anne-Marie J. Audet, a policy specialist for the nonprofit Commonwealth Fund, a health research foundation that helped pay for the recent study.
The Obama administration, as it seeks money to provide health care for more Americans, has already identified hospital readmissions as a source of potential cost-cutting. The president’s budget calls for $26 billion in savings from readmissions over 10 years, which includes lowering payments to hospitals with high numbers of patients who are readmitted.
Many elderly patients who leave the hospital with a chronic illness like heart failure or diabetes are left to cope largely on their own. They often do not receive clear instructions on what medications they should be taking, and they frequently have difficulties making doctor appointments to continue their treatment outside the hospital.
“When you get out of the hospital, you need to have an active interaction with the health system,” said Dr. Audet of the Commonwealth Fund, which also provided a grant to the nonprofit Institute for Healthcare Improvement to work with states to try to reduce the number of times patients go back to the hospital. “The patient has to be seen.”
Some hospitals have already shown they can reduce readmissions by taking seemingly simple steps to make sure patients get necessary follow-up care when they go home or to a nursing facility.
At Geisinger Health System, a network in Pennsylvania that has been a leader in improving the quality of hospital care, doctors say they are taking varied approaches to reducing readmissions rates, depending on why the patient was initially hospitalized.
With surgery patients, for example, Geisinger has focused on educating people before they come to the hospital about what they are likely to experience and what they should expect when they leave. The effort could reduce readmission rates by as much as 20 percent, said Dr. Ronald A. Paulus, a senior executive at the health system. Geisinger’s early findings, he said, indicate that if patients “are not ready by the time they come in, it’s too late.”
Geisinger has also found it effective to alert the patients’ doctor about the hospital visit, including a brief summary of the patient’s discharge plan that is sent the doctor within 72 hours of the patient’s departure. That kind of simple step, Dr. Paulus noted, does not require an overhaul of the current system.
Successful measures elsewhere have included working more closely with patients or their caregivers to better manage conditions like diabetes, said Dr. Eric A. Coleman, one of the study’s authors and a policy specialist at the University of Colorado at Denver. Coaching patients to be more diligent about taking their medicine and recognizing when their condition is deteriorating helps people stay out of the hospital, he said.
But Dr. Coleman also said doctors needed to take more responsibility for their patients’ continuing care. “Physicians haven’t really been stepping up to the plate and taking on this accountability,” he said, although he said several professional societies were expected this spring to clarify the doctors’ roles.
Many policy analysts say that insurers like Medicare must change the way they pay hospitals and doctors — rewarding medical providers that help patients get and stay better. Under the current system, reducing the number of returning patients can work against the financial interests of a hospital needing to fill empty beds. About one in four of the nation’s hospitals derive 25 percent of their admissions from return visits by patients, according to the study.
“Reducing admissions in a hospital is quite punitive in today’s environment,” said Dr. Amy E. Boutwell, a policy specialist at the Institute for Healthcare Improvement. The institute is working with states including Massachusetts, Washington and Michigan to determine how to change the payment system to encourage hospitals to work more closely with doctors and others to prevent needless round trips.