Some hospitals, especially safety net providers, care for disproportionate numbers of lower-income patients who live in communities without other healthcare services and resources essential for follow-up care, such as primary-care physicians and pharmacies. As a result, no matter what the hospital does, some patients might not be able to get the follow-up care they need.
“The strategies that hospitals are using, a lot of them are some of the same,” said Akin Demehin, director of policy for the American Hospital Association. “But certainly the challenges that they may face in their own patient population, in their own communities, in their own space, could look a little bit different.”
In other cases, patients or families are given instructions for care after discharge. But that doesn't mean they can, or will, follow them.
“A lot of folks go home and just feel unprepared and start to panic,” Coleman said. Preventing avoidable readmissions “really is about preparing patients and families to be able to feel confident in their own self-care.”
And sometimes, a patient's insurance will not cover the post-acute care services he or she needs, or will pay for only a portion.
“We've tried a lot of things—we make sure people have a follow-up appointment, we do arrange for visiting nurses, we'll place them in some sort of chronic-care facility if possible. Often, it's not,” said Radford, of NYU Langone. “The payment models don't help here. Some people don't have coverage for that type of thing.”
Of the 49 states where readmissions fell from 2010 to 2015, 43 saw decreases of more than 5%, and rates fell by more than 10% in 11 states. The one state where Medicare's 30-day, all-condition hospital readmission rate rose was Vermont—from 15.3% in 2010 to 15.4% in 2015, which the CMS described as “virtually unchanged.”
And according to hospital leaders there, the state may be seeing what others throughout the country are about to experience: doing well on readmissions means lower rates of improvement.
“While Vermont's readmission rates may not have changed drastically, they remain lower than in more than half of other states,” said Jeffrey Tieman, CEO of the Vermont Association of Hospitals and Health Systems. The state's rate in 2010 was 1.3 percentage points below the median, according to CMS data.
“Our hospitals recognize that it can be hard to make progress on these types of measures when your state is already a strong performer,” Tieman said. “But they are focused on continuing to reduce readmissions even further by improving the way we coordinate and integrate care.”