Steady Hospital Readmission Rates Prove Costly for Medicare
Could hospital readmissions be costing you money?
Hospital readmissions have long been viewed as a sign of issues within the health care system by government officials and health care policy experts. Avoidable rehospitalizations not only denote poor quality of care, but also a risk of high health care costs. According to a study released by the Commonwealth Fund, a nonprofit research foundation, a quarter of heart-failure patients and a third of heart-attack patients are readmitted to hospitals; these readmissions have cost Medicare $17 billion per year.
In response to concern on readmissions, many U.S. hospitals have started implementing new approaches to ensure follow-up checkups, medication, and support for released patients to prevent them from being hospitalized again.
However, hospitals have made little progress in reducing patient readmission rates, according to recently released Medicare data.
Despite the overall number of Medicare beneficiaries being readmitted having declined, the national hospital readmission rate remains steady. Medicare calculates readmission rates over a period of three years, with the most recent data being taken from July 2008 to the end of June 2011. Medicare publically tracks readmission rates for three medical conditions: heart disease, heart failure, and pneumonia.
Not everyone agrees with these findings. Nancy Foster, a vice president at the American Hospital Association, has stated that these findings downplay improvements made in the last year given the prior two years of readmission data. She suspects that more patients are being better managed in the ambulatory setting and that sicker patients, who end up being admitted, are more likely to return and be readmitted into the hospital. Additionally, industry and health policy experts believe that patients intentionally returning or being readmitted to the hospital for new, unrelated ailments, are not properly counted in Medicare’s calculations.
Others argue that hospitals with high readmissions may actually be doing a better job in keeping their Medicare patients alive than most. Both Boston’s Beth Israel Deaconess Medical Center and Los Angeles’ Olympia Medical Center have higher than average admission rates, but lower rates of mortality within 30 days of discharge for all three medical conditions.
Nonetheless, starting in October, Medicare will start penalizing hospitals with higher readmission rates than expected as a result of the Affordable Care Act.
The government will also be providing $500 million in grants to assist hospitals and health-care providers in reducing hospital readmissions and improving care transitions. Additionally, 154 accountable care organizations (ACOs) have been government-approved to further improve care. These ACOs, collaborations between health care providers, agree to provide quality care, reduce readmission rates, and cut health care costs for all Medicare beneficiaries in return for financial incentives.
Brian Cook, a spokesman for the Centers of Medicare and Medicaid Services has stated, “The improvements we have made over the past year will lead to better care and lower costs for patients.” Medicare officials have stated that they expect their efforts to bring positive results.
Medicare has not reviewed or endorsed this information.