by James A. Bacon
In an effort to rein in runaway health care costs, policy wonks are paying close attention these days to a key metric of hospital quality and productivity: hospital readmissions. If too many patients are readmitted to the hospital shortly after they are discharged, it’s a sign that something could be wrong. Perhaps some patients are being released too early. Perhaps there is a disconnect in follow-up care with doctors outside the hospital.
In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers with the Dartmouth Atlas Project found wide variations in 30-day readmission rates across regions and academic medical centers. More than half of Medicare patients discharged home do not see a primary care clinician within two weeks of leaving the hospital. “The report highlights widespread and systematic failures in coordinating care for patients after they leave the hospital,” said David C. Goodman, lead author of the study. “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.”
Centers for Medicare & Medicaid Services has estimated the cost of avoidable readmissions at more than $17 billion a year in a Medicare budget that exceeds $500 billion yearly. Despite the focus on readmissions in recent years, Dartmouth Atlas researchers see little progress being made in this metric.
As you can see in the map above (click to view the map in more detail), Virginia hospitals are far from the worst offenders in the country. But they have ample room for improvement. Compare the performance locally with that of Utah, Idaho, Colorado, Oregon and New Mexico. In one of the few productivity-oriented cost control provisions to emerge from Obamacare, Medicare will start in 2013 to reduce reimbursements to hospitals deemed to have an excessive number of readmissions. That should concentrate administrators’ minds wonderfully on the need for coordinated care. It’s not clear, however, that the problem resides entirely with the hospitals. Do physicians bear any responsibility? Do patients or their caretakers? Could this be a job best tackled by the entire medical community?
Stay tuned. As the cost of health care insurance takes an ever bigger bite out of business budgets and family pocketbooks, hospital readmissions is a problem that Virginians policy makers will have to grapple with.