Readmission numbers held steady for Medicare patients in years before CMS penalties: report
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Hospital readmission rates for Medicare patients remained steady between 2008 and 2010, with variations between regions, according to a report released Monday.
Published by the Robert Wood Johnson Foundation, the report looks at hospital readmission rates among Medicare beneficiaries in 306 regions tracked by The Dartmouth Institute for Health Policy & Clinical Practice. Nationally, the 30-day hospital readmission rate for Medicare beneficiaries did not change much between 2008 and 2010, the Dartmouth researchers found. The rate of readmission following medical discharge was found to be highest in the Bronx, NY, at 18.1%.
The medical readmission rate for all admitted patients fell from 16.2% to 15.9%. Readmission rates for congestive heart failure and acute myocardial infarction patients fell slightly in the two-year time period.
The Centers for Medicare & Medicaid Services began fining hospitals with high readmission rates related to CHF, pneumonia and heart attacks in October. This penalty system has “intensified” providers' focus on bringing down readmissions, the researchers noted.
Communities that rely heavily on hospitals as primary caregiving sites are likely to see a higher readmission rate, researchers said. Poor coordination of acute and post-acute care is a major factor leading to readmissions.
“Most important is the lack of clarity regarding the clinician who is responsible following discharge; accountability is scattered among hospital staff, community physicians and nurses, skilled nursing facilities, and families,” the report authors wrote. “Without clear accountability, problems that could be prevented are missed, leading to emergency room visits and repeat hospitalizations.”
Healthcare payment system innovations, such as accountable care organizations, should play a role in bringing down the Medicare readmission rate, the researchers stated. The report comes less than two weeks after CMS announced more than 165 nursing home operators will take part in a bundled payments initiative aimed to improve care coordination.