MediMedia Managed Markets
Managed Care magazine
P&T Community, The Online Resource for P&T Decision Makers
Login / Register
Join Us  Facebook  Twitter  Linked In






New Medicare Data Show High Rates of Hospital Readmissions in Some States

Experts question readmission measures (January 6)

Medicare’s new comprehensive measure of hospital readmissions shows that at least 20% of the hospitals in Illinois, Maryland, Massachusetts, New Jersey, New York, and Rhode Island have higher rates of patients returning than the national average.

Colorado, Hawaii, Idaho, North Carolina, Oregon, South Carolina, Utah, and Washington led the states with the highest proportion of hospitals with low readmission rates. In those states, between 13% and 16% of hospitals came in below the national average, the data show.

Since 2008, Medicare has been tracking hospital readmission rates and publishing those rates for three common ailments. In December, the government expanded its disclosure by publishing hospital rates of Medicare patients for all diagnoses who returned within 1 month for unplanned reasons. At 364 hospitals (8%), patients returned more frequently than did those at the average hospitals. Some of these facilities are among the most respected in the country, such as the Cleveland Clinic and Duke University Hospital in Durham, N.C.

Patients at 315 hospitals — 7% of those rated across the country — were readmitted at a lower rate than the national average. These hospitals included Baylor University Medical Center in Dallas, California Pacific Medical Center in San Francisco, and Intermountain Medical Center in Murray, Utah. The rest of the nation’s hospitals were rated as average.

The all-cause readmission rates are particularly significant because the Medicare Payment Advisory Commission (MedPAC), which advises Congress, has encouraged lawmakers to use this measure when determining financial penalties for hospitals in the Hospital Readmission Reduction Program. Medicare is currently fining 2,225 hospitals for excess readmissions for patients with heart failure, heart attack, or pneumonia.

The hospital industry and some independent researchers have expressed reservations about Medicare’s readmission measures. They say that the measures do not reflect that some hospitals save lives by being more aggressive in readmitting patients at early signs of trouble. They also complain that hospitals with large proportions of low-income patients often have higher readmission rates because those patients often don’t have the money for follow-up care and are more likely to lack their own primary care physician.

Sources: Kaiser Health News; January 6, 2014; and Medicare, January 2014.

More stories