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

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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.

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