New York Times Editorial - "Back in the Hospital Again"

April 16, 2009

An alarming one-fifth of all Medicare patients discharged from the hospital end up back in the hospital within 30 days, and fully a third return within 90 days. If this yo-yoing could be greatly reduced, Medicare could save billions of dollars. Many patients would certainly benefit from the better care.

High rates of rehospitalization are partly the fault of the hospitals. The more fundamental problem is the fragmented nature of the American medical system: too often, health-care providers fail to communicate with one another, patients fall between the cracks and no one seems clearly in charge of a patient's welfare.

A new analysis by three researchers, published in The New England Journal of Medicine, estimated that unplanned rehospitalizations among fee-for-service beneficiaries cost Medicare $17.4 billion in fiscal year 2004, which is a big chunk of the $102.6 billion that Medicare paid hospitals that year.

Most patients were readmitted for problems other than those that led to their original hospitalizations. Surgical patients, for example, were typically readmitted for such medical conditions as pneumonia, heart failure or bacterial infections. Some of these readmissions may have been unavoidable in an elderly, sick population. But many could surely have been prevented through better planning and coordination.

The most disturbing finding was that half of the medical (nonsurgical) patients readmitted within 30 days had not seen a physician for follow-up care after they were discharged. They were apparently left on their own, perhaps with poorly understood instructions from the hospital on how to take care of themselves.

There was also wide variation in readmission rates between hospitals and between states: only 13 percent of patients were readmitted within 30 days in Idaho, compared with 22 percent in Maryland. That suggests that there is plenty of room for improvement. The rates were adjusted to compensate for the severity of patients' illnesses, so hospitals and states with high readmission rates can't easily blame caring for sicker patients.

Proposed solutions include better discharge planning by hospitals, more effective education of patients and closer cooperation between hospitals and physicians to ensure follow-up care.

The Obama administration, as part of its ambitious health care reform, has proposed that Medicare use incentives and penalties to encourage hospitals and doctors to cooperate in overseeing care from hospitalization through the first 30 days after discharge. The administration estimates the approach could save $26 billion over 10 years. It is a sound idea that should also improve the lives of patients.