Up to One-Fifth of Medicare Beneficiaries Are Readmitted to Hospitals Within 30 Days of Being Discharged, Study Finds

As many as one-fifth of Medicare beneficiaries are readmitted to a hospital within 30 days of being discharged, costing the U.S. health care system billions of dollars for care that could be prevented, according to a study published on Thursday in the New England Journal of Medicine, the New York Times reports (Abelson, New York Times, 4/2). For the study, Mark Williams, chief of hospital medicine at Northwestern University's Feinberg School of Medicine, and colleagues analyzed Medicare claims data for nearly 12 million beneficiaries between Oct. 1, 2003, and Dec. 31, 2004.

The study found that 19.6% of beneficiaries were readmitted within 30 days of their initial discharge, 34% within 90 days and 56.1% within 12 months (Shelton, Chicago Tribune, 4/1). The study also found that about half of the beneficiaries who were readmitted in the first month did not see a physician prior to returning to the hospital. Researchers noted that about 10% of the readmissions likely were scheduled in advance for a planned surgical procedure (Nano, AP/Austin American-Statesman, 4/1). According to the study, readmission rates also varied among states. Idaho had the lowest readmission rate at 13%, while Washington, D.C., had the highest rate at 23%.

The study estimated that the unplanned readmissions cost Medicare about $17.4 billion in 2004. Overall, Medicare paid hospitals $103 billion that year. The top five common medical conditions that required readmission were heart failure, pneumonia, chronic obstructive pulmonary disease, psychoses and gastrointestinal problems. The top five common surgical procedures requiring readmission were cardiac stent placement, major hip or knee surgery, vascular surgery, major bowel surgery, and other hip or femur surgery (Chicago Tribune, 4/2). "Rehospitalization is a frequent, costly and sometimes life-threatening event that is associated with gaps in follow-up care," the study stated.

According to the study, patients need to schedule follow-up appointments with their physicians before they leave the hospital. Study co-author Stephen Jencks said failure to follow up with a physician is "unsafe because, as this study shows, almost all of these patients are high-risk" (Favole, Wall Street Journal, 4/2). In addition, Jencks said hospitals should provide patients with a list of medications, instructions for what to do at home and information about whom to call if there is a problem. Hospitals also should check on patients within two days of their discharge and inform patients' physicians that they were in the hospital (AP/Austin American-Statesman, 4/1).

In an editorial accompanying the study, Arnold Epstein, chair of the Department of Health Policy and Management at Harvard School of Public Health, wrote, "These high rates may result, in part, from inadequate coordination of care and poor discharge planning, since half of the patients who were readmitted within 30 days had no ambulatory visit before the rehospitalization." According to Epstein, "Although some patients may have been in close contact with doctors by telephone, these figures still raise questions about transitions between hospital and ambulatory care and complement a substantial body of other evidence that shows suboptimal coordination of care at the time of discharge" (Chicago Tribune, 4/2).

An abstract of the study is available online. The editorial also is available online.