Report Finds Hospitals Not Meeting Medicare Readmission Goals, Facing Penalties
Medicare to reduce payments for readmissions, exposing hospitals to considerable financial risks; first report shows
stagnant performance, variations in care
Sept. 29, 2011 - As scorekeeping begins for new Medicare penalties for hospitals with excessive numbers of patients
returning shortly after they are discharged, a new Dartmouth Atlas Project report shows little progress over a five-year period in reducing
these hospital readmissions and improving care coordination for Medicare patients.
On the contrary, readmission rates for some conditions have increased nationally and for many regions and at hospitals,
including some of America’s most elite academic medical centers. The report shows that roughly one in six Medicare patients wind up back in
the hospital within a month after being discharged for a medical condition.
In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers found striking
variation in 30-day readmission rates across regions and academic medical centers.
Almost 7% of acute-care hospitals had higher-than-expected readmissions rates for heart failure, heart attack or
By Jordan Rau, KHN Staff Writer
Aug.1, 2011 - When hospitals discharge patients, they typically see their job as done. But soon, they
could be on the hook for what happens after Medicare patients leave the premises, and particularly if they are readmitted within a month.
Researchers also found that more than half of Medicare patients discharged home do not see a primary care clinician
within two weeks of leaving the hospital, and that facilities and regions with general patterns of high use of hospitals for medical
conditions were frequently the same places with high readmission rates, an indication that some communities are more likely than others to
rely on the hospital as a site of care across the board.
“The report highlights widespread and systematic failures in coordinating care for patients after they leave the
hospital,” said David C. Goodman, M.D., M.S., lead author and co-principal investigator for the Dartmouth Atlas Project, and director of the
Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H.
“Irrespective of the cause, unnecessary hospital readmissions lead to more tests and treatments, more time away from home
and family, and higher health care costs.”
The readmission rate to a hospital is increasingly seen as a marker of a local health care system’s ability to coordinate
care for patients across care settings, and readmissions are often a sign of inadequate discharge planning and the lack of effective
community-based care. CMS has estimated the cost of avoidable readmissions at more than $17 billion a year.
In hopes of decreasing these costs, Medicare plans to reduce payments for readmissions, exposing hospitals to
considerable financial risks. In fiscal year 2013, hospitals face a penalty equal to 1 percent of their total Medicare billings if an
excessive number of patients are readmitted. The penalty rises to 2 percent in 2014 and 3 percent in 2015.
“The need to develop more efficient systems of care that include discharge planning and care coordination is clear,”
said Elliott S. Fisher, M.D., M.P.H., report author and co-principal investigator of the Dartmouth Atlas Project and director of the Center
for Population Health at the Dartmouth Institute for Health Care Policy and Clinical Practice.
“The report shows the opportunity for improvement, and the importance of aligning efforts to reduce readmissions with
other policy and payment initiatives.”
Trends over time in 30-day readmission rates
Nationally, there was relatively little change in 30-day readmission rates from 2004 to 2009, regardless of the cause of
the initial hospitalization. Readmission rates following surgery were 12.7 percent in both 2004 and 2009, while readmission rates for medical
conditions rose slightly from 15.9 percent in 2004 to 16.1 percent in 2009.
Similarly, most regions across the country did not experience significant reductions in readmissions from 2004 to 2009.
Readmissions decreased after medical discharges in 11 regions, with Bismarck, N.D. experiencing the largest decrease, from 16.3 percent in
2004 to 14 percent in 2009.
There was an increase in readmissions in 27 regions, the highest in Aurora, Ill., which increased from 14.3 percent in
2004 to 18 percent in 2009. Readmission rates after surgeries varied as well, with 28 regions experiencing a decrease, most notably in Elyria,
Ohio, which decreased from 19 percent in 2004 to 15.2 percent in 2009. White Plains, N.Y. was among the 18 regions with increases in
readmission rates following surgical discharges, with an increase from 13 percent in 2004 to 17.4 percent in 2009.
Other coverage of the Dartmouth Atlas
Readmission Rates Reflect Problem In Addressing Hospital Failures
The Wall Street Journal's Health Blog:How One Hospital Reduced Its Readmission
you're a Medicare patient admitted to the hospital, the odds are about one in six that you’ll end up back in the hospital within a
month. And there was very little progress made in reducing that rate between 2004-09.
That's the not-so-good news
from a new report by the folks at the Dartmouth Atlas Project, which tracks variations in medical care across the U.S. The report also
found that more than half of Medicare patients who left the hospital didn't see a primary-care doctor within two weeks of discharge —
identified as a contributing factor to the revolving-door problem (Hobson, 9/28).
The Hill: Report: Hospitals Across The Country Failing Patients After Discharge
Hospitals across the country are doing a dismal job making sure their patients stay healthy after they have been discharged, according
to a new report released Wednesday.
Readmission rates have
actually increased nationally for some conditions over the past five years, according to the Dartmouth Atlas Project, which tracks
regional variations in care. The new data come as hospitals with high readmission rates will start seeing Medicare reimbursement cuts
under the health care reform law, starting in October 2012. (Pecquet, 9/28).
Only seven academic medical centers had significant changes in 30-day readmission rates following medical discharge from
2004 to 2009. Northwestern Memorial Hospital in Chicago, Ill. showed the most decrease, from 19.9 percent in 2004 to 16.7 percent in 2009,
while the University of Connecticut Health Center in Farmington, Conn. increased from 13.1 percent to 17.9 percent.
Among patients discharged after surgery, 11 academic medical centers experienced significant changes in 30-day
readmission rates between 2004 and 2009. The University of Missouri Hospital and Clinic in Columbia, Mo. decreased from 19.7 percent of
patients in 2004 to 14.5 percent in 2009, while Montefiore Medical Center in the Bronx, N.Y. increased from 15.6 percent to 19.4 percent.
Regional variation in 30-day readmission rates
In 2009, the percentage of patients readmitted to the hospital within 30 days of an initial discharge varied markedly for
both medical and surgical discharges across regions of the country. Among patients who first visited the hospital for medical treatment, 16.1
percent were admitted to the hospital within 30 days.
The highest rates occurred in Michigan, including Pontiac (18.9%), Royal Oak (18.8%), Dearborn (18.0%) and Detroit
(17.9%), while far lower rates were found in Utah, including Ogden (11.5%), Provo (13.0%) and Salt Lake City (13.6%). For patients who were
discharged from the hospital after having surgery, 12.7 percent was readmitted to the hospital within 30 days.
However, there was more than twofold variation in these rates in regions across the U.S., from Rapid City, S.D. (7.5%) to
the Bronx, N.Y. (19.0%).
Primary care follow-up after discharge
Overall, 42.9 percent of patients who were released to go home from the hospital after medical treatment had a primary
care visit within two weeks in 2009. Patients in New Orleans, La. were far less likely to see a primary care clinician after discharge home,
with 25.6 percent having a visit to a primary care clinician within two weeks of medical treatment in a hospital, compared to 61.4 percent of
patients in Lincoln, Neb.
Among academic medical centers, the range of variation was somewhat higher. Less than 20 percent of patients discharged
from New York University Medical Center in Manhattan, N.Y. saw a primary care clinician within two weeks of a medical discharge, while the
rate was nearly three times higher at the Mayo Clinic’s St. Mary’s Hospital in Rochester, Minn.
These findings highlight the pervasive problems with patient care after hospital discharge, and underscore the importance
of primary care systems in reducing avoidable hospitalizations. While there are many different reasons for higher readmission rates across
regions and hospitals, prior research has documented the failings of current care coordination and the high proportion of readmissions that
can be avoided by improving care.
“It’s very important that patients and health care providers communicate clearly so that all questions are answered and
everyone understands what will happen when the patient leaves the hospital,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the
Robert Wood Johnson Foundation, a longtime funder of the Dartmouth Atlas Project.
“Everyone – patients, doctors, nurses, caregivers – has a role to play in ensuring quality care and avoiding another
hospital stay. They need to work together to create a plan for how care will proceed when the patient returns home. This should include a
clear understanding of the patient’s medical problems, a schedule for follow-up appointments, a list of medications and instructions for
As part of the Care About Your Care initiative, the Dartmouth Atlas Project and Robert Wood Johnson Foundation have
co-produced a companion to the report with tips for patients when they leave the hospital. A link to the full report, After Hospitalization: A
Dartmouth Atlas Report on Post-Acute Care for Medicare Beneficiaries, complete data tables and the patient companion can be found at
Sept. 12, 2011 – Senior citizens are already receiving information on the 2012 drug plans from their Medicare Part D
insurance companies. Registration for next year is coming earlier this year – it has been changed to open October 15 and end on December 7 in 2011.
Researchers studied 100% of fee-for-service Medicare beneficiaries with full
Part A and Part B coverage during the study periods. Hospital claims from short-term acute or critical access hospitals were identified among
the study population for each cohort, with the first period of index discharges as July 1, 2003 -June 30, 2004 and the second as July 1, 2008
-June 30, 2009. Because of the way hospitals are paid under Medicare in Maryland, readmission rates for Maryland hospital referral regions
were suppressed. Data was adjusted for differences in age, sex and race.
About the Dartmouth Atlas Project
For more than 20 years, the Dartmouth Atlas Project has documented glaring
variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and
analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians. This research has helped
policymakers, the media, health care analysts and others improve their understanding of our health care system and forms the foundation for
many of the ongoing efforts to improve health and health systems across America.
About the Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health
care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with
a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable and timely change. For nearly 40
years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health
care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a
difference in your lifetime. For more information, visit www.rwjf.org.
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