One in three adult patients discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new study by the Center for Studying Health System Change (HSC), and that puts them at risk of readmission.
The study was conducted for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR). The findings are detailed in the NIHCR research brief, “Physician Visits After Hospital Discharge: Implications for Reducing Readmissions.”
The study found that even 90 days after discharge, 17.6 percent still had not seen a physician, nurse practitioner or physician assistant.
Many adults who do not see a physician after discharge are at high risk of readmission because of chronic conditions or physical activity limitations, according to the study, which used 2000-08 data from the nationally representative Medical Expenditure Panel Survey (MEPS) to estimate the prevalence of hospital readmissions for all causes – other than obstetrical care – for adults aged 21 and older.
“Once patients leave the hospital, the system breaks down, and it breaks down for some of the sickest patients who need follow-up care the most, people who are at high risk of readmission because they have disabilities or are managing multiple chronic conditions,” said HSC Senior Researcher Anna Sommers, PhD, coauthor of the study with Peter J. Cunningham, PhD, HSC director of quantitative research.
According to the study, expenditures for hospital readmissions up to 30 days after discharge were $16.3 billion on an annual basis.
“While much of the policy focus has been on changing payment incentives in Medicare to decrease readmissions, private insurance pays for a greater share of 30-day readmissions (about 47 percent) than does Medicare (about 40 percent),” the study noted.
“Reducing readmissions is not just about hospitals doing their part," said Sommers. "Clinicians in the community, to do their part, require support to identify patients who need follow-up care and who are at high risk of readmission. They also need evidence-based research, which is lacking, about how best to manage the care of the most complex cases, people with multiple chronic conditions.”
Other key study findings include:
• About one in 12 adults (8.2 percent) aged 21 and older discharged from a hospital to the community was readmitted within 30 days
• One in three adults (32.9 percent) was rehospitalized within one year of discharge.
• Thirty-day readmission rates are much higher for people who are sicker, ranging from 5 percent for adults in excellent or very good health to about double that for people in fair to poor health.
• Among adults aged 21 to 64, readmission rates were highest for people with public coverage, mainly Medicare or Medicaid. These higher rates, in part, reflect the relatively poor health of people under age 65 who qualify for Medicare or Medicaid based on disability.
• The vast majority of people admitted to a hospital reported having a usual source of care (90 percent). However, having a usual source of care does not guarantee easy access to a provider. Only about a third of people with a usual source of care reported that after-hours care – night nights and weekends – was available, and about one-fifth said it was difficult to contact their usual source of care by phone about a health problem. One in 10 reported difficulty getting to their usual source of care, which may reflect long travel times or lack of transportation.