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Hospitals That Serve the Most People Have More Readmissions

Regions of the U.S. with the highest hospital admission rates also see patients return most often, Harvard University researchers found.

A study in the New England Journal of Medicine today supports federal efforts to improve the coordination of care between doctors and hospitals to cut admissions, said the author, Arnold Epstein, a professor of health policy at the Harvard School of Public Health in Boston.

The government will reduce Medicare payments to hospitals with higher-than-average readmission rates beginning in October because returning patients are seen as an indicator of poor care.

“The government needs to go past there and address system-wide incentives,” said Epstein in a phone interview. “We need a broad array of approaches.”

Initial admissions are the strongest predictor of readmission rates, not whether hospitals instruct discharged patients on how to care for themselves, the study showed.

The link between admissions and readmissions is “a real phenomenon and it’s quite a strong effect,” said David Goodman, the director of Dartmouth College’s Center for Health Policy Research in Lebanon, New Hampshire. Admissions tend to be higher in places like New York, where there are many hospital beds, he said in a telephone interview.

“Hospitals are generally unaware of whether they have low or high discharge rates,” he said.

Variations In Readmissions

Nationwide, rates of readmission within 30 days after hospitalization for congestive heart failure range from 11 to 32 percent of patients, Epstein’s study showed.

Epstein and his co-authors analyzed Medicare data from the first half of 2008 to identify four factors that could predict a readmission and help explain the variation. They include whether patients in an area with high numbers of readmissions were sicker than average, whether they receive discharge instructions, whether doctors or hospital beds are in short supply and overall hospital admission rates.

Only admission rates showed a strong correlation with readmissions in analysis that included all of the variables, the study showed. Admission rates explained 16 percent of the variation between different regions, the study said. Discharge instructions by comparison only accounted for about half a percent of the difference, according to the study.

“Programs directed at shared savings from lower utilization of hospital services might be more successful in reducing readmissions than” the planned payment reductions, the study said.

Medicare will begin paying bonuses next year to hospitals and physicians who can reduce medical spending by their patients as part of so-called accountable care organizations.

Goodman agreed that the program may help stem readmissions. Policy makers should also try to address differences in admissions across the country, he said.

“A bed that’s not filled by readmission by good efforts just gets filled up by another patient who, in another region, wouldn’t be admitted at all,” he said. “We run the risk of ignoring some of these broader and arguably more important patterns” by focusing on readmissions, he said.

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