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 new study.
According to the study, supported by The Commonwealth Fund and appearing in today's New England Journal of Medicine, unplanned re-hospitalizations cost Medicare $17.4 billion in 2004.
"Re-hospitalizations Among Patients in the Medicare Fee-for-Service Program," by Stephen Jencks, MD, MPH, Mark V. Williams, MD, and Eric A. Coleman, MD, MPH, highlights the costs and health impact of re-hospitalization. It also details the key reasons for re-hospitalizations and highlights gaps in patient management that may be contributing to the high rates.
"Healthcare 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 Vice President Anne-Marie Audet, MD. "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 healthcare system billions of dollars and strengthen the primary care system."
Researchers found wide variations in re-hospitalization rates among states. Between October 2003 and December 2004, the five states with the highest re-hospitalization rates (Maryland, New Jersey, Louisiana, Illinois and Mississippi) were 45 percent higher than the five states with the lowest rates (Idaho, Utah, Oregon, Colorado and New Mexico).
Most patients were readmitted for conditions other than those for which they were originally hospitalized. 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 authors suggest several steps to reduce re-hospitalizations, including educting patients about self-care in the hospital discharge process; helping hospitals better understand comparative performance on readmissions by providing readmission data for their patients (including those who were re-hospitalized 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 re-hospitalized soon after discharge with no bill for a physician visit in between," said Jencks. "If we want to prevent unplanned re-hospitalizations, 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," he added. "Doing less is unsafe because, as this study shows, almost all of these patients are high risk – two-thirds will be re-hospitalized or die within a year of leaving the hospital."