Jessica N. Mittler, Ph.D., Jennifer L. O’Hora, Jillian B. Harvey, M.P.H, Matthew J. Press, M.D., M.Sc., Kevin G. Volpp, M.D., Ph.D., and Dennis P. Scanlon, Ph.D.
The federal government has begun penalizing hospitals it determines to have excess patient readmission rates for certain conditions. An analysis of a program implemented in three states to reduce preventable readmissions statewide identified three key obstacles to success: 1) forming productive, collaborative relationships across care settings; 2) identifying effective interventions, especially across settings; and 3) addressing a lack of quality improvement capabilities among some health care providers. To see rapid, widespread reductions in readmission rates, public policy should help remove these barriers.
Each year, one of five Medicare beneficiaries returns to the hospital within 30 days of discharge, costing the program roughly $18 billion. Many such readmissions are thought to be preventable with better care. In an effort to reduce readmission rates, Medicare has begun financially penalizing hospitals deemed to have excess readmissions for heart attacks, congestive heart failure, or pneumonia. In this Commonwealth Fund–supported study, researchers examine the early experiences of participants in the State Action on Avoidable Rehospitalizations (STAAR) initiative, a four-year effort begun by the Institute for Healthcare Improvement in 2009 and supported by The Commonwealth Fund. The program, which was implemented in Massachusetts, Michigan, and Washington, set ambitious goals for improvement—20 percent to 30 percent reductions in readmission rates—and involved providers from across the health care continuum.
Efforts to reduce hospital readmissions on a large scale will need to focus explicitly on promoting real collaboration across care settings, taking into account both economic and human factors, the authors say. The federal Community-Based Care Transitions Program, recently launched to support partnerships between hospitals and community organizations, should provide practical lessons to help guide these efforts. And given that hospitals with limited resources for quality improvement are especially at risk for incurring Medicare’s new penalties, policymakers should consider providing support for training in quality improvement methodologies, as well as incentives for achieving degrees of improvement.
Researchers conducted 52 interviews in 2011, about two years after STAAR began, with national program leaders, state STAAR directors, improvement advisers, hospital participants, postacute care providers, members of professional associations, and health care policy leaders.
Changing economic incentives for hospitals may not be sufficient to encourage rapid, widespread reduction of readmission rates. Extensive efforts will be needed to identify effective interventions and encourage care coordination.