Hospitals and their community allies made little progress between 2008 and 2010 in reducing hospital readmissions for seniors, according to a new report from the Robert Wood Johnson Foundation, and geographic location plays a large role in determining the rate of rehospitalization.
In 2010, one in six patients returned to the hospital within 30 days of leaving after receiving medical care. Readmissions did not decrease significantly between 2008 and 2010.
Readmissions for Medicare beneficiaries cost about $26 billion each year, according to the federal government. More than $17 billion of that is spent on preventable readmissions that could have been avoided if patients had received proper post-acute care.
Many rehospitalizations are caused by a lack of discharge planning and poor care coordination between the hospital and the community clinicians, according to a report on analysis of Medicare data by the Dartmouth Atlas Project.
Patients’ chances of being readmitted depend largely on where they live, along with the hospital in which they received care, says the report.
“The burden of readmissions falls unevenly on Medicare beneficiaries, and is closely linked to their place of residence and the health system providing their care,” the Dartmouth researchers wrote. “Patients with similar illness have very different chances of hospital readmission depending on where they live. The variation in the quality of care between health systems is hard for patients and doctors to see, but the differences are substantial. Many patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care for illness, leading to both higher initial admissions and higher readmissions.”
Getting people the care they need outside of the hospital is imperative, says Risa Lavizzo-Mourey, MD, president and CEO of the Robert Wood Johnson Foundation in the introduction to the report.
Discharge management with followup, patient coaching, disease/health management, and provision of telehealth services are among interventions shown to have positive benefits on readmission rates, and several programs have been implemented under the Affordable Care Act with the goal of coordinating care and reducing readmission rates.
Some readmissions are unavoidable, the report acknowledges.
“[A] patient may return to an assisted living facility after an admission for congestive heart failure, but despite having received the influenza vaccine, he
may contract a virus that worsens his heart condition and need to be readmitted,” the researchers said. “Not all illnesses can be anticipated nor can all readmissions be prevented. But many can.”
Read the Robert Wood Johnson Foundation report on U.S. Hospital Readmissions.
Written by Alyssa Gerace