Studies in JAMA examine hospital readmissions and effects of new Medicare penalties

Research shows that poor coordination among providers can lead to patients returning to the hospital. In addition, the new payment procedures are likely to affect academic medical centers and safety net hospitals.

The Wall Street Journal: Return Patients Vex Hospitals
Hospitals fearing new Medicare penalties are trying to reduce the number of patients who need to return soon after discharge, a problem that new research suggests is widespread and without an easy fix. Several studies published online Tuesday in JAMA, the Journal of the American Medical Association, suggest that poor coordination among different providers after patients leave the hospital is largely to blame for many readmissions, and the focus should be on improving that care. Hospitals may fail to identify patients at high risk for complications or new illnesses that may land them back in the hospital, and there is often insufficient help for patients to make the transition from hospital to home (Landro, 1/22).

Bloomberg: Medicare Cuts For Readmissions To Target Large Hospitals
Large U.S. teaching hospitals such as those affiliated with major universities are more likely to be penalized under a U.S. program linking Medicare pay cuts to higher rates of patient readmission, research suggests. About 67 percent of 3,282 hospitals studied will receive lower payments for providing care to patients in Medicare, the U.S. government's health program for the elderly and disabled, as a result of the policy that took effect on Oct. 1, according to a research letter published today in the Journal of the American Medical Association (Armour, 1/22).

Reuters: Poor U.S. Hospitals Likeliest To Pay Readmission Fine
Large teaching hospitals and hospitals that primarily provide care to poor and uninsured patients are most likely to lose federal money under the U.S. government's plan to improve quality by tying payments to readmissions, according to new research (Seaman, 1/22).

Medscape: Readmission Penalty Hits Safety Net, Teaching Hospitals Hard
Ninety-five-bed Falmouth (Massachusetts) Hospital on Cape Cod doesn't have the national reputation of Massachusetts General Hospital, 77 miles to the north in Boston. But the small hospital bests the big teaching hospital in the big city on this point -- it's not getting penalized by Medicare for excessive readmissions within 30 days of discharge. Massachusetts General, in contrast, will forego about 0.5 percent of its Medicare reimbursement in fiscal year 2013 because its readmission rate was higher than what the Centers for Medicare & Medicaid Services (CMS) projected based on the case mix, or medical complexity, of their patients (Lowes, 1/22).

Medpage Today: Big Hospitals To Be Biggest Losers Of Federal $$
Large, teaching, and safety-net hospitals are those most likely to be penalized for failing to reduce hospital readmissions, researchers found. In the federal Hospital Readmissions Reduction Program (HRRP), 40 percent of large hospitals will likely see big cuts in their fiscal 2013 Medicare reimbursements compared with 28 percent of small hospitals, according to Karen Joynt, MD, of Brigham and Women's Hospital in Boston, and Ashish Jha, MD, of the Harvard School of Public Health. In addition, major teaching hospitals are more likely to be highly penalized than nonteaching hospitals (44 percent versus 33 percent) as are safety-net hospitals compared with hospitals that do not have the safety net designation (44 percent versus 30 percent), they wrote in a research letter in the Journal of the American Medical Association online (Petrochko, 1/22).

In other news related to readmissions --

Medpage Today: Kids' Hospital Readmissions Vary Widely
Readmission rates vary widely across pediatric acute care hospitals, and multiple patient and disease factors contribute, a retrospective study suggested. The 30-day readmission rate for hospitals with high readmission rates was 7.2 percent compared with 5.6 percent for centers with low readmission rates, a difference of 28.6 percent, according to Jay G. Berry, MD, of Harvard Medical School, and colleagues. But rates rose significantly depending on the number of chronic conditions for individual patients (Walsh, 1/22).

Medpage Today: ER Visits Common After Hospital Stay
Nearly one-fifth of hospital patients returned for acute care within 30 days of discharge, with emergency room (ER) visits accounting for 40 percent of those encounters, a large multistate study found. Among some 5 million hospitalizations, involving about 4 million unique patients in California, Florida, and Nebraska over a 15-month period in 2008 and 2009, 17.9 percent of discharges were followed within 30 days by a "treat-and-release" ER visit or readmission, according to Anita Vashi, MD, MPH, of Yale University, and colleagues (Gever, 1/22).