Nearly one in five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, costing the U.S. social insurance program $17.4 billion annually. Northwestern University researchers said the findings underscore the need for better patient preparation for the transition to home as well as better coordination with primary care physicians. In a sign of the lack of coordination, a full half of non-surgical patients are readmitted to the hospital without having seen an outpatient doctor in follow-up, says the New England Journal of Medicine study.

 

“We were surprised that more than half of these patients weren’t being seen by their primary care doctors before they went back into the hospital,” says study co-author  Mark Williams, chief of hospital medicine for Northwestern’s Feinberg School and for Northwestern Memorial Hospital. “This represents a major disconnect between care in the hospital and outside it. We’ve got to do better.”

 

The study finds that the readmission rates rise with time. Some 19.6 percent of patients were readmitted within 30 days of discharge. Within 90 days, the amount of readmissions rose to 34 percent. And within a year, it was 56.1 percent. When patients are readmitted after surgery, 70 percent of them suffer from a medical problem such as a urinary tract infection or pneumonia, the study finds. The study looked at Medicare fee-for-service claims data for nearly 12 million Medicare beneficiaries discharged from a hospital in 2003 and 2004.

 

Williams says Medicare and other insurers pay for readmissions except for those within 24 hours of discharge. He says that the reimbursement likely contributes to lack of effort to decrease the readmissions.

 

“They pay for quantity of service, not quality,” Williams says of the insurers. “While insurers will pay thousands of dollars for a hospitalization, they do not target payments to improve patient understanding of their care and the need for follow up. Hospitals and doctors are rewarded for ‘doing things’ instead of preventing them.”

 

Williams and the other authors suggest several steps to reduce rehospitalizations. Among them, hospitals could better educate patients about self-care in the hospital discharge process. Officials could also help hospitals better understand their comparative performance on readmissions by providing them readmission data for their patients including those who were rehospitalized elsewhere. There’s also a need to foster better collaboration between physicians and hospitals to ensure patients get follow-up care. That care would include follow-up care from a primary care doctor as well as a surgeon for surgery patients.

 

“We strongly encourage our residents and hospitalists to communicate directly with the primary care doctor on admission and at discharge,” Williams says.