September 28, 2011 / 5:20 AM / in 6 years

US hospitals face challenge to reduce readmissions

* Dartmouth study finds 1 in 6 patients readmitted

* Hospitals face Medicare deadline to reduce readmissions

By Susan Kelly

Sept 28 (Reuters) - About one in six Medicare patients is readmitted to the hospital within a month of being discharged, indicating room for improvement before financial penalties for high readmission rates kick in next year, a large study found.

Medicare plans to reduce payments to hospitals with excessive readmissions by 1 percent beginning in October 2012 as part of President Obama’s healthcare reform. The penalty rises to 3 percent in fiscal 2015.

The reimbursement cuts by Medicare, which provides medical coverage for about 45 million elderly Americans, are part of an initiative to reduce wasteful spending and improve the quality of patient care.

The study, by the Dartmouth Institute for Health Policy and Clinical Practice, found little change in 30-day readmission rates in hospitals across the country over a five-year period ending in 2009, regardless of the cause of the initial hospitalization.

Readmission rates after surgery were 12.7 percent in both 2004 and 2009, while readmission rates for medical conditions rose slightly to 16.1 percent in 2009 from 15.9 percent five years before.

“For a long-standing and well-recognized problem, not much progress has been made,” Dr. David Goodman, the study’s lead author and a principal investigator for the Dartmouth Atlas Project, told reporters on a telephone conference.

The Dartmouth Atlas Project, which specializes in research on variations in Medicare usage, looked at 10.7 million hospital discharges for Medicare patients to analyze readmission rates.

The researchers also found that more than half of discharged Medicare patients did not see a primary care clinician within two weeks of leaving the hospital. Follow-up appointments reduce readmissions and improve patient outcomes, Goodman said.

“Emergency rooms, on the other hand, are too often the place where patients end up being seen. Unfortunately many of those emergency room visits are the portal of entry back into the hospital for admission,” Goodman said.

Regions of the country with high readmission rates also tended to show general patterns of high hospital use for medical conditions, indicating that some communities rely more heavily on the local hospital for care across the board, according to the study, which received funding from the Robert Wood Johnson Foundation.

A separate study by Consumer Reports, released on Tuesday, found 20 percent of patients hospitalized for heart attack, heart failure or pneumonia were readmitted to the hospital within 30 days of their initial discharge.

Consumer Reports, which looked at Medicare data for 2,432 hospitals between July 2007 and June 2010, said it found many hospitals fail to give adequate information to patients about the care they’ll need after they leave the hospital. (Reporting by Susan Kelly in Chicago; Editing by Phil Berlowitz)

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