Harvard study focuses on hospital readmission rates
December 28, 2011
Winston-Salem Journal Published December 27, 2011
By Richard Craver
The increasing use of hospital services may be contributing more to high readmission rates than the severity of patients' conditions or the care they receive after being discharged, according to researchers at the Harvard School of Public Health.
The study, which appears in the Dec. 15 issue of the New England Journal of Medicine, is the latest research on a hot-button health care issue related to cost and quality of care.
The Centers for Medicaid and Medicare Services (CMS) says the focus on readmission rates is pivotal because one out of three Medicare beneficiaries who leave the hospital today will be back in the hospital within a month.
Avoidable readmissions cost Medicare an estimated $12 billion annually, said Karen Southard, program manager for Patient Safety/Care Transitions at the Carolinas Center for Medical Excellence.
The researchers said most efforts to reduce readmission rates have focused on improving transitional care — what happens to patients at discharge and shortly after they're released from the hospital.
For example, Forsyth Medical Center and Wake Forest Baptist Medical Center have formed a partnership aimed at enlisting local nonprofit organizations to help reduce readmission rates by at least 20 percent, hospital officials said. An estimated 3,000 Medicare patients in Forsyth County and the surrounding areas could be affected by the initiative to reduce readmission rates, officials said.
The Harvard researchers say the problem is much broader than improving transitional care.
"Hospitals may have limited ability to reduce readmissions," said Arnold Epstein, chairman of the Department of Health Policy and Management at the Harvard school.
"The responsibility for readmissions lies with the entire delivery system. Meaningful progress may require incentives directed at that level and a change in culture."
The Harvard researchers said previous studies have shown that efforts to improve hospital-discharge planning have not significantly decreased readmission rates.
The Harvard researchers used national Medicare data from the first six months of 2008 to calculate the 30-, 60- and 90-day readmission rates among patients discharged with congestive heart failure or pneumonia.
They examined overall hospitalization rates as well as differences in patients' coexisting conditions, the quality of discharge planning, and the number of physicians and hospital beds in each region to review how each factor affected readmissions.
The results showed that readmission rates among regions ranged from 11 percent to 32 percent among patients with congestive heart failure, and from 8 percent to 27 percent among those with pneumonia. Greater severity of coexisting conditions was associated with higher regional readmission rates.
The Harvard researchers recommend that payers use programs that include shared savings with health care providers, such as accountable care organizations, that are able to reduce readmission rates and bring down the overall cost of care.
Officials from Forsyth and Wake Forest Baptist said they plan to file an application soon for federal money available through CMS that would help pay for their community initiative.
The federal money requested by the hospitals would go to local nonprofit organizations, such as Senior Services, The Shepherd Center and Hospice & Palliative CareCenter, among others, because they can provide services that fall outside the realm of what hospitals normally do, officials said.
In November, the Winston-Salem Journal reported that a Medicare study found that N.C. Baptist Hospital performed worse than the national average for Medicare patients who were readmitted within 30 days of their release after treatment for heart failure or pneumonia.
The results come from the Hospital Compare report provided by CMS. The report measured data from July 1, 2007, through June 30, 2010.
By comparison, Forsyth's readmission rates for Medicare patients who suffered from pneumonia, heart attacks or heart failure are no different than the U.S. average.
Baptist officials, responding to the results, vigorously defended the hospital's quality of care. They pointed to a U.S. News & World Report-sponsored study that found better performances by Baptist using some of the same Medicare data in ways they say better reflect Baptist's overall performance.
Unlike the Medicare report, the U.S. News & World Report survey does not include results on readmission rates.
Baptist officials said although the government's performance review has merit, the results don't fully take into account how many very sick Medicare patients from 20 counties end up at Baptist, often referred from other emergency rooms.
Medicare officials said the death and readmission rates are risk-adjusted, which means they take into account several factors, such as indigent care and emergency room situations, so that hospitals in low-income areas or serving as trauma centers, for example, do not unfairly rate worse than the national average.
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