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Percent Of Hospitalized Medicare Patients Readmitted To Hospital Within
30 Days
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 Commonwealth
Fund-supported study.
All told, unplanned rehospitalizations cost
Medicare $17.4 billion in 2004, the study says. The study,
"Rehospitalizations Among Patients in the Medicare Fee-for-Service
Program," by Dr. Stephen Jencks, Dr. Mark V. Williams, and Dr. Eric A.
Coleman, highlights the costs and health impact of rehospitalization.
It also details the key reasons for rehospitalizations, 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 Dr. Anne-Marie
Audet, "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."
The researchers found wide variation in
rehospitalization rates among states. Between October 2003 and December
2004, the five states with the highest rehospitalization rates
(Maryland, New Jersey, Louisiana, Illinois, and Mississippi) had rates
45 percent higher than the five states with the lowest rates (Idaho,
Utah, Oregon, Colorado, and New Mexico).
They also found variation in the reasons for
rehospitalization. Most patients were rehospitalized for conditions
other than those for which they were originally hospitalized. The
rehospitalizations were so rapid that these conditions should probably
have been the focus of discharge planning in many cases. 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 study also showed that a history of
rehospitalization and prolonged length of hospital stay were stronger
predictors ofrehospitalization than age, gender, race, poverty, or
disability.
The authors suggested several steps to reduce
rehospitalizations including:
- interventions to better educate patients about
self-care in the hospital discharge process; helping hospitals better
understand their comparative
- performance on readmissions by providing them
readmission data for their patients including those who were
rehospitalized 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 rehospitalized soon after discharge with no bill for a
physician visit in between," said Jencks. "If we want to prevent
unplanned rehospitalizations, 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. Doing less is unsafe because, as this study shows,
almost all of these patients are high risk — two-thirds will
be rehospitalized or die within a year of leaving the hospital."
The study was published in the New England Journal
of Medicine.
Address: The Commonwealth Fund, One East 75th
Street, New York, NY 10021; (212) 606-3800, www.cmwf.org.
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