Care coordination for Medicare patients discharged from hospitals has not progressed much in the past five years, according to a report from the Dartmouth Atlas Project.

With funding from the Robert Wood Johnson Foundation, researchers examined the records of 10.7 million hospital discharges representing 100% of fee-for-service Medicare beneficiaries with full Part A and B coverage during two study periods (July 2003-June 2004 and July 2008-June 2009). Their analysis showed little change in U.S. 30-day re-admission rates, regardless of the cause of the initial hospitalization. Surgical 30-day readmission rates were 12.7% in 2004 and 2009, while medical 30-day readmission rates were 16.1% in 2009, up slightly from 15.9% in 2004.

“Generally, during this time period, this is really a static problem,” Dr. David Goodman, the study's lead author and co-principal investigator for the Dartmouth Atlas Project, said during a call with reporters a day before the report's official release. “Although there was a variation by region in readmission rates, there is no place that stands out as having low readmission rates.”

Meanwhile, the study found that in 2009, the percentage of patients readmitted to a hospital for both medical and surgical discharges varied considerably across the country. The highest rates were found in Michigan, while much lower rates were found in Utah. And the researchers also found variation at selected academic medical centers. Just seven academic medical centers had notable changes in 30-day readmission rates following medical discharge during the five-year study period, with Chicago's Northwestern Memorial Hospital showing the largest decrease: 16.7% in 2009, compared with 19.9% in 2004. There were 11 medical centers that showed changes in 30-day readmission rates for patients discharged after surgery, with the University of Missouri Hospital and Clinic in Columbia improving to a rate of 14.5% in 2009, compared with 19.7% in 2004.

“The causes of the variation in 30-day readmission rates across academic medical centers are as diverse as those driving regional variation,” the study said. “Some of this variation is expected, due to differences in patient populations and to care patterns that may keep less ill patients out of the hospital initially,” it continued. “Nevertheless, some of this variation represents opportunities for improving care that may lead to fewer hospital days and better outcomes.”

The study also noted that beginning in 2013, hospitals in the Medicare program will begin facing a penalty equal to 1%—climbing to 2% in 2014 and 3% in 2015—of their total Medicare billings for excessive hospital readmissions.