Hospital Readmissions

A major trend in health care over the last few years has been the identification of examples of allegedly widespread poor quality care and linking of reimbursement policy to those poor care instances.  The “never events” initiative, for example, has led to non-payment for certain adverse outcomes during a hospitalization.  Medicare began this program, which was quickly adopted by private payers.  The current primary target is hospital readmissions, which account for substantial spending and are often perceived as unnecessary or avoidable.  The California Office of Statewide Health Planning and Development has released a report on readmissions in that state.  (OSPHD Report)

Hospitalizations in 2005 and 2006 were looked at for characteristics of readmissions.  About one-third of patients were readmitted at least once and almost 10% had three or more rehospitalizations.    The most common diagnoses associated with readmission were heart failure (61% readmitted), COPD (55%), kidney failure (54%), psychoses (48%), kidney infections (48%) and pneumonia (47%).  About 13% of the readmissions occurred within one week and a third occurred within thirty days of discharge.  While older persons were more likely to have a readmission, the likelihood of multiple readmissions was actually highest among middle-aged adults.

Half of Medicare patients had a readmission and about a third of hospitalized Medicaid recipients had one.  Only 25% of privately insured or self-pay patients were readmitted.  Readmissions accounted for half of the total Medicare or Medicaid payments for hospitalizations and about 36% of private insurance hospital spending.  Readmission rates varied significantly across hospitals and geographic regions.  Two things suggested by the data are that more attention may need to be paid to the after-hospitalization care of middle-aged patients, not just that of the very old; and psychiatric hospitalizations and readmissions may need more focussed management as well.