Hospital patients who are readmitted soon after their discharge are at the center of a push by lawmakers looking for health care savings and streamlined patient care.
Many regulators see readmissions, also known as rehospitalizations, as a relatively easy target for reform. However, hospital leaders stress that real improvement would require sweeping changes in care delivery and coordination, payment methodologies, and even the formula used for defining and evaluating readmissions.
"It is not something that can be turned on like a switch," said Ruben Amarasingham, M.D., M.B.A., associate chief of medicine at Parkland Health and Hospital System and assistant professor of medicine at the University of Texas Southwestern Medical Center at Dallas. "You really have to optimize every aspect of inpatient care, the patient transition as they are preparing for discharge, and the care they receive after discharge. And on top of that, the patient must also be involved in learning what he or she needs to do not to return to the hospital. There has to be a systemic, methodical approach."
An April report in the New England Journal of Medicine found that almost 20 percent of the nearly 12 million Medicare beneficiaries who had been discharged from a hospital between 2003 and 2004 were rehospitalized within 30 days, and 34 percent were rehospitalized within 90 days. Unplanned hospital readmissions cost Medicare $17.4 billion during that time frame, according to the study. A 2007 report by the Medicare Payment Advisory Commission (MedPAC) found that Medicare paid an average of $7,200 dollars per readmission deemed potentially preventable.
Beginning this month, the Centers for Medicare and Medicaid Services (CMS) is posting on its Hospital Compare Web site the readmission rates for Medicare patients who are readmitted within 30 days of the original admission date due to heart failure, heart attack, or pneumonia.
Readmissions reform could be particularly important to teaching hospitals, which tend to admit—and readmit— patients with severe and chronic conditions. According to a recent University HealthSystem Consortium analysis of approximately 100 members of the AAMC's Council of Teaching Hospital and Health Systems, Medicare patients with a higher severity of illness have higher readmission rates—as high as 22 percent within 30 days for the most severe cases.
Meanwhile, President Barack Obama's fiscal 2010 budget calls for $26 billion in savings from readmissions over 10 years, and MedPAC and the Congressional Budget Office have suggested payment reductions for hospitals with high readmission rates. Congress also is interested in readmission payment policy. In late April, the Senate Finance Committee released a paper on reducing Medicare costs that included a readmission payment policy. New policies could reduce payments to hospitals with high, risk-adjusted readmission rates for "potentially preventable" conditions.
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