MANAGED CARE March 2013. ©MediMedia USA

News & Commentary

Readmission Study Offers No Quick Fix

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Efforts to limit readmissions to hospitals, including penalties enacted last year by the government, might not be enough to stem the problem in a meaningful way for several reasons.

For one thing, people tend to be more vulnerable after they come home from the hospital, says a study in the Journal of the American Medical Association.

“The broad range of acute conditions responsible for readmission may reflect a post-hospitalization syndrome — a generalized vulnerability to illness among recently discharged patients, many of whom have developed new impairments both during and after hospitalization,” says the study “Diagnosis and Timing of 30-Day Readmissions After Hospitalization for Heart Failure, Acute Myocardial Infarction, or Pneumonia.” (Abstract: http://tinyurl.com/JAMA-readmissions.)

The Centers for Medicare & Medicaid Services last year began reducing base payments to hospitals that showed too many readmissions for those three conditions.

The JAMA study looked at data from 2007 through 2009 for 330,000 30-day readmissions for heart failure, 109,000 readmissions for MI, and 214,000 for pneumonia.

It finds that 25 percent of those with heart failure, 20 percent with MI, and 18 percent with pneumonia are readmitted within the 30-day period for which hospitals can be penalized, and that “the entire 30-day period after discharge is one of heightened vulnerability to readmission from a wide variety of illnesses.”

The readmission problem cuts across all demographic categories, suggesting that “hospitals should account for a fairly standard spectrum of readmission diagnoses when designing and implementing interventions....”

Better communication among providers might help, and a care plan should include interacting with patients earlier.

The authors say that “strategies involving the combination of inpatient and early outpatient interventions with the use of tools to facilitate cross-site communication have lowered readmissions that occur soon after discharge. However, because about one third of 30-day readmissions occurred during days 16 through 30 after hospitalization, many patients require substantial attention well beyond the initial follow-up visit.”

Readmissions for HF are more likely later in the month; for pneumonia, soon after discharge. But “these differences involved less than 6 percent of all readmissions.”