Rehospitalizations are miserable for patients, and a huge cost — more than $17 billion a year in avoidable Medicare bills alone — for a nation struggling with the price of health care.
Make no mistake, not all readmissions are preventable. But many are, if patients are given the right information and outpatient support.
The new Dartmouth Atlas evaluated Medicare records for 2008 to 2010, the latest publicly available data, to check progress just before Medicare cracked down. In October, the government began fining more than 2,000 hospitals where too many patients with heart failure, pneumonia or a heart attack had to be readmitted in recent years.
"Change is hard and comes slowly," said Dartmouth's Dr. David Goodman, who led the work.
Of seniors hospitalized for nonsurgical reasons, 15.9% were readmitted within a month in 2010, barely budging from 16.2% in 2008. Surgery readmissions aren't quite as frequent — 12.4% in 2010, compared with 12.7% in 2008. That's probably because the surgeon tends to provide some follow-up care.
Medicare's Blum told the AP that the government is closely tracking more recent, unpublished claims data that show readmissions are starting to drop. He wouldn't say by how much or whether that means fewer hospitals will face penalties next year when the maximum fines are scheduled to rise.
But by combining the penalties with other programs aimed at improving these transitions in care, "we have now changed the conversation," Blum said. "Two years ago, the response was, 'This is impossible.' Now it's, 'OK, let's figure out what works.'"
Hence interest in the geographic variation.
Some 18% of nonsurgical patients, the highest rate, are readmitted within a month in the New York City borough of the Bronx. Rates are nearly that high in Detroit, Lexington, Ky., and Worcester, Mass.
Yet the readmission rate in Ogden, Utah, is just 11.4%. Half a dozen other areas — including Salt Lake City, Muskegon, Mich., and Bloomington, Ill. — keep those rates below 13%.
For surgical patients, Bend, Ore., gets readmissions down to 7.6%.
Some studies suggest part of the variation is because certain hospitals care for sicker or poorer patients, especially in big cities. Yet Minneapolis, for example, has readmission rates just below the national average. Goodman said whether local doctors' stress outpatient care over hospitalization, and how many hospital beds an area has play big roles, too.