Profession

1 in 5 Medicare patients readmitted within a month after hospital release

A study of 13 million discharges finds wide variations in readmission rates. Experts say better planning and follow-up can help prevent rehospitalizations.

By Kevin B. O’Reilly — Posted April 16, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Nearly 20% of Medicare patients discharged from hospitals were readmitted within 30 days, costing taxpayers $17.4 billion, according to an April 2 study in the New England Journal of Medicine.

About 10% of rehospitalizations were planned to continue needed care, the study found. But as many as 40% of them -- or about 1 million readmissions -- were preventable, said Stephen F. Jencks, MD, MPH, lead author of the study (link).

"It is very clear that high rehospitalization rates are not ordained," Dr. Jencks said at a news conference. "When it is preventable, rehospitalization is a terrible waste of money, and many are preventable."

Dr. Jencks and his co-authors analyzed Centers for Medicare & Medicaid Services claims data on hospital discharges of Medicare patients in 2003 and 2004. The rates varied widely among states and individual hospitals. The top five states -- Louisiana, Illinois, West Virginia, Kentucky and Mississippi -- had rehospitalization rates 45% higher than the five lowest states -- Idaho, Oregon, Colorado, New Mexico and Montana. The top quarter of high-readmission hospitals had rates 83% greater than hospitals in the bottom quarter on readmissions.

A panel of experts who spoke at a news conference organized by the New York-based nonprofit Commonwealth Fund said many readmissions can be attributed to the natural progression of patients' illnesses and the toll comorbidities can take on the elderly. But, they added, there are steps hospitals, physicians, patients and families can take to prevent needless rehospitalizations.

"It is the discontinuity of care in transitioning from inpatient care to ambulatory care that is the source of the problem," said Paul M. Schyve, MD, senior vice president of the Joint Commission, which accredits hospitals.

Dr. Schyve and other experts said hospitals and doctors should begin discharge planning early, help guide patients and families through the process, and help arrange outpatient services for follow-up. Primary care physicians, meanwhile, should get updates on the hospital care their patients received and notes on their progress.

The Medicare Payment Advisory Commission recommended last year that hospitals' risk-adjusted rehospitalization rates be made public. MedPAC also said hospitals with relatively high rehospitalization rates should have their reimbursements reduced.

Back to top


ADVERTISEMENT

ADVERTISE HERE


Featured
Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story


Read story

Goodbye

American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story


Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story


Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story


Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story


Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story


Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story


Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn