Many hospitals may be unprepared for a new Medicare requirement to lower readmissions, and could face resulting financial penalties over the next few years, according to a new report from the Dartmouth Atlas Project.
Over a 5-year period, hospitals made little progress in reducing readmissions among Medicare beneficiaries aged 65 years and older. The Dartmouth Atlas researchers found that surgical 30-day readmission rates were 12.7% in both 2004 and 2009, and medical 30-day readmission rates rose from 15.9% in 2004 to 16.1% in 2009.
They found similar trends when they looked at specific conditions. For example, the national readmission rates for hip fractures were 14.3% in 2004, compared with 14.5% in 2009. The rates were also relatively unchanged for congestive heart failure (20.9% vs. 21.2%) and pneumonia (15.1% vs. 15.3%). However, U.S. hospitals showed some improvement in acute myocardial infarctions, reducing 30-day readmissions from 19.4% in 2004 to 18.5% in 2009.
"For a long-standing and well-recognized problem, not much progress has been made," Dr. David C. Goodman, the study’s lead author and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, said during a press conference to release the findings.
The researchers analyzed data for fee-for-service Medicare beneficiaries aged 65 years and older who lived in 306 Dartmouth Atlas hospital referral regions and had both Part A and Part B Medicare coverage.
Hospital readmissions have garnered significant attention in the health care community since the passage of the Affordable Care Act. The new health law calls on the Centers for Medicare and Medicaid Services to start measuring 30-day hospital readmission rates and to penalize poor performers. In October 2012, hospitals with high readmission rates will face penalties of 1% of their total Medicare billings. The penalty increases to 2% the following year.
Part of the solution to reducing hospital readmissions is good discharge planning, Dr. Goodman said. "This sounds simple but often doesn’t happen."
That planning should include having the care team in the hospital develop a care plan and communicate that plan to the patient and their family. It also means ensuring that the patient has all the necessary prescriptions, understands what medications to take and when, and can get their prescriptions. And health care providers in the hospital should also help patients set up follow-up appointments with their primary care physician, Dr. Goodman said.
But aside from discharge planning, there are also "hidden" factors such as how local patterns of hospital use affect readmission rates. Dr. Goodman and his colleagues found that communities and health care systems with higher underlying admission rates also tended to have higher rates of hospital readmission.
The Dartmouth Atlas Project receives most of its funding from the Robert Wood Johnson Foundation, the National Institute on Aging, the California Healthcare Foundation, the United Healthcare Foundation, and the WellPoint Foundation. The researchers reported no financial conflicts.