Readmissions to Hospital Are Frequent and Costly, New Study Finds

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One of five Medicare beneficiaries discharged from the hospital is readmitted within 30 days, and half of patients admitted for reasons other than surgery are readmitted without having seen a doctor in follow-up, according to a Commonwealth Fund-supported study in the new issue of the New England Journal of Medicine. All told, unplanned rehospitalizations cost Medicare $17.4 billion in 2004.

The researchers also found wide variation in rehospitalization rates among states. Between October 2003 and December 2004, the five states with the highest rehospitalization rates (Maryland, New Jersey, Louisiana, Illinois, and Mississippi) had rates 45 percent higher than the five states with the lowest rates (Idaho, Utah, Oregon, Colorado, and New Mexico).

"You have to worry about a system in which patients are rehospitalized soon after discharge with no bill for a physician visit in between," said Stephen Jencks, M.D., M.P.H., the study's lead author. "If we want to prevent unplanned rehospitalizations, we have to help hospitals and community healthcare providers implement transition procedures that are more patient-centered."

Most patients were rehospitalized for conditions other than those for which they were originally hospitalized. The rehospitalizations were so rapid that these conditions should probably have been the focus of discharge planning in many cases, the researchers said.

"As policymakers debate reform proposals, it’s important for them to consider policies that will foster care integration and coordination while encouraging hospitals to reduce readmissions," said Commonwealth Fund Vice President Anne-Marie Audet, M.D. "Payment reform that provides the right incentives for patient-centered care is a win for everyone."

Webinar Today on Readmissions

Today at 2 p.m., E.D.T., The Commonwealth Fund is hosting the webinar, "Reducing Rehospitalizations: A National Priority." Coauthor Stephen F. Jencks, M.D., M.P.H., Consultant in Health Care Safety and Quality, will review the New England Journal of Medicine study's findings.

Other panelists include:

  • Paul M. Schyve, M.D., Senior Vice President, The Joint Commission
  • Anne Mutti, M.P.A., Senior Analyst, Medicare Payment Advisory Commission
  • Carol Wagner, Vice President, Patient Safety, Washington State Hospital Association.

Physician reactors include:

  • Study coauthor Mark V. Williams, M.D., F.A.C.P., F.H.M., Professor and Chief, Division of Hospital Medicine, Northwestern University Feinberg School of Medicine
  • Eric A. Coleman, M.D., M.P.H., Care Transitions Program, Division of Health Care Policy and Research, University of Colorado at Denver
  • Amy Boutwell, M.D., M.P.P., principal investigator of the Fund-supported Institute for Healthcare Improvement state initiative to reduce readmissions.

Commonwealth Fund Senior Vice President Anne-Marie J. Audet, M.D., M.Sc., who directs the Quality Improvement and Efficiency Program, will moderate. To register, go to: