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Hospital readmission rates continue to hover at around 16% for medical discharges and 12% for surgical conditions, despite the existence of several proven protocols for improving the discharge process.
A new analysis of Medicare data conducted by the Dartmouth Atlas Project, and supported by the Robert Wood Johnson Foundation, shows that readmission rates are virtually unchanged between 2008 and 2010. This follows an earlier report from the Dartmouth Atlas Project showing that readmission rates failed to improve between 2004 and 2009.
"We still have a very persistent problem," Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said during a panel discussion on the report on Feb. 13 in Washington.
The national rate for 30-day readmissions for medical conditions was 16.2% in 2008 and 15.9% in 2010. Similarly, the 30-day surgical readmission rates were 12.7% in 2008 and 12.4% in 2010. The same trends hold true when looking at readmission rates for heart failure, acute myocardial infarction, and pneumonia, the conditions that held accountable for as part of a new Medicare readmissions penalty that went into effect in October 2012.
Readmission rates for heart failure were dipped slightly from 21.4% in 2008 to 21.1% in 2010. Acute myocardial infarction readmissions went from 18.7% to 18.1% during the same time period. And pneumonia readmission rates stayed at 15.3% in both 2008 and 2010.
The researchers called the progress on readmissions "slow and inconsistent." But while there has been little change nationally among the Medicare population, there is widespread regional variation, according to the analysis.
For instance, 30-day readmission rates following medical discharge ranged from a low of 11.4% in Ogden, Utah, to a high of 18.1% in the Bronx, N.Y., in 2010. There was even greater variation in readmissions following surgery. Surgical readmission rates ranged from 7.6% in Bend, Oregon, to 18.3% in the New York.
"People who have the same illness often have very different chances of being readmitted depending on where they live," Dr. Lavizzo-Mourey said.
Many patients are readmitted simply because their local hospital is the community’s main source of care, the researchers wrote. This trend results in both higher initial hospital admissions and readmissions, they wrote.
But while the report highlights the lack of progress, there are some success stories, Dr. Lavizzo-Mourey said. For instance, some hospitals are establishing 24-hour pharmacies so that patients can get their prescriptions no matter what time they are discharged. Others are setting up clinics to specialize in the care of patients with heart failure, a condition with a high rate of bounce-back to the hospital. And other hospitals are working with community organizations to ensure patients have the care and support they need when they go home, she said.
"This issue of readmissions is firmly on the radar screen of our health care providers," Dr. Lavizzo-Mourey said.
Dr. Eric Coleman, who runs the Care Transitions Program aimed at improving the safety of hand-offs, said one of the issues that leads to readmissions is the poor engagement of patients and family members before discharge.
At the University of Colorado, Denver, where he heads the division of health care policy and research, Dr. Coleman said they try to avoid simply dumping information on patients and families and instead use a process called "skill transfer" to train them to be able to handle their own care at home without the help of health care providers.
But many of the causes of readmissions are beyond the control of the hospital, Dr. Coleman said. He encourages physicians to go the bedside and ask patients why they think they were readmitted to the hospital. The answers are often about a lack of transportation to appointments, struggles to afford medicine and care, or family caregivers who are burning out.
"It may be that hospitals don’t have the resources to address this but a lot of their community partners, such as the area agencies on aging do have that opportunity," Dr. Coleman said.
Hospital readmission rates continue to hover at around 16% for medical discharges and 12% for surgical conditions, despite the existence of several proven protocols for improving the discharge process.
A new analysis of Medicare data conducted by the Dartmouth Atlas Project, and supported by the Robert Wood Johnson Foundation, shows that readmission rates are virtually unchanged between 2008 and 2010. This follows an earlier report from the Dartmouth Atlas Project showing that readmission rates failed to improve between 2004 and 2009.
"We still have a very persistent problem," Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said during a panel discussion on the report on Feb. 13 in Washington.
The national rate for 30-day readmissions for medical conditions was 16.2% in 2008 and 15.9% in 2010. Similarly, the 30-day surgical readmission rates were 12.7% in 2008 and 12.4% in 2010. The same trends hold true when looking at readmission rates for heart failure, acute myocardial infarction, and pneumonia, the conditions that held accountable for as part of a new Medicare readmissions penalty that went into effect in October 2012.
Readmission rates for heart failure were dipped slightly from 21.4% in 2008 to 21.1% in 2010. Acute myocardial infarction readmissions went from 18.7% to 18.1% during the same time period. And pneumonia readmission rates stayed at 15.3% in both 2008 and 2010.
The researchers called the progress on readmissions "slow and inconsistent." But while there has been little change nationally among the Medicare population, there is widespread regional variation, according to the analysis.
For instance, 30-day readmission rates following medical discharge ranged from a low of 11.4% in Ogden, Utah, to a high of 18.1% in the Bronx, N.Y., in 2010. There was even greater variation in readmissions following surgery. Surgical readmission rates ranged from 7.6% in Bend, Oregon, to 18.3% in the New York.
"People who have the same illness often have very different chances of being readmitted depending on where they live," Dr. Lavizzo-Mourey said.
Many patients are readmitted simply because their local hospital is the community’s main source of care, the researchers wrote. This trend results in both higher initial hospital admissions and readmissions, they wrote.
But while the report highlights the lack of progress, there are some success stories, Dr. Lavizzo-Mourey said. For instance, some hospitals are establishing 24-hour pharmacies so that patients can get their prescriptions no matter what time they are discharged. Others are setting up clinics to specialize in the care of patients with heart failure, a condition with a high rate of bounce-back to the hospital. And other hospitals are working with community organizations to ensure patients have the care and support they need when they go home, she said.
"This issue of readmissions is firmly on the radar screen of our health care providers," Dr. Lavizzo-Mourey said.
Dr. Eric Coleman, who runs the Care Transitions Program aimed at improving the safety of hand-offs, said one of the issues that leads to readmissions is the poor engagement of patients and family members before discharge.
At the University of Colorado, Denver, where he heads the division of health care policy and research, Dr. Coleman said they try to avoid simply dumping information on patients and families and instead use a process called "skill transfer" to train them to be able to handle their own care at home without the help of health care providers.
But many of the causes of readmissions are beyond the control of the hospital, Dr. Coleman said. He encourages physicians to go the bedside and ask patients why they think they were readmitted to the hospital. The answers are often about a lack of transportation to appointments, struggles to afford medicine and care, or family caregivers who are burning out.
"It may be that hospitals don’t have the resources to address this but a lot of their community partners, such as the area agencies on aging do have that opportunity," Dr. Coleman said.
Hospital readmission rates continue to hover at around 16% for medical discharges and 12% for surgical conditions, despite the existence of several proven protocols for improving the discharge process.
A new analysis of Medicare data conducted by the Dartmouth Atlas Project, and supported by the Robert Wood Johnson Foundation, shows that readmission rates are virtually unchanged between 2008 and 2010. This follows an earlier report from the Dartmouth Atlas Project showing that readmission rates failed to improve between 2004 and 2009.
"We still have a very persistent problem," Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said during a panel discussion on the report on Feb. 13 in Washington.
The national rate for 30-day readmissions for medical conditions was 16.2% in 2008 and 15.9% in 2010. Similarly, the 30-day surgical readmission rates were 12.7% in 2008 and 12.4% in 2010. The same trends hold true when looking at readmission rates for heart failure, acute myocardial infarction, and pneumonia, the conditions that held accountable for as part of a new Medicare readmissions penalty that went into effect in October 2012.
Readmission rates for heart failure were dipped slightly from 21.4% in 2008 to 21.1% in 2010. Acute myocardial infarction readmissions went from 18.7% to 18.1% during the same time period. And pneumonia readmission rates stayed at 15.3% in both 2008 and 2010.
The researchers called the progress on readmissions "slow and inconsistent." But while there has been little change nationally among the Medicare population, there is widespread regional variation, according to the analysis.
For instance, 30-day readmission rates following medical discharge ranged from a low of 11.4% in Ogden, Utah, to a high of 18.1% in the Bronx, N.Y., in 2010. There was even greater variation in readmissions following surgery. Surgical readmission rates ranged from 7.6% in Bend, Oregon, to 18.3% in the New York.
"People who have the same illness often have very different chances of being readmitted depending on where they live," Dr. Lavizzo-Mourey said.
Many patients are readmitted simply because their local hospital is the community’s main source of care, the researchers wrote. This trend results in both higher initial hospital admissions and readmissions, they wrote.
But while the report highlights the lack of progress, there are some success stories, Dr. Lavizzo-Mourey said. For instance, some hospitals are establishing 24-hour pharmacies so that patients can get their prescriptions no matter what time they are discharged. Others are setting up clinics to specialize in the care of patients with heart failure, a condition with a high rate of bounce-back to the hospital. And other hospitals are working with community organizations to ensure patients have the care and support they need when they go home, she said.
"This issue of readmissions is firmly on the radar screen of our health care providers," Dr. Lavizzo-Mourey said.
Dr. Eric Coleman, who runs the Care Transitions Program aimed at improving the safety of hand-offs, said one of the issues that leads to readmissions is the poor engagement of patients and family members before discharge.
At the University of Colorado, Denver, where he heads the division of health care policy and research, Dr. Coleman said they try to avoid simply dumping information on patients and families and instead use a process called "skill transfer" to train them to be able to handle their own care at home without the help of health care providers.
But many of the causes of readmissions are beyond the control of the hospital, Dr. Coleman said. He encourages physicians to go the bedside and ask patients why they think they were readmitted to the hospital. The answers are often about a lack of transportation to appointments, struggles to afford medicine and care, or family caregivers who are burning out.
"It may be that hospitals don’t have the resources to address this but a lot of their community partners, such as the area agencies on aging do have that opportunity," Dr. Coleman said.
