A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Primer on One of the Next Big Things -- Preventable Hospital Readmissions

Primer on One of the Next Big Things -- Preventable Hospital Readmissions

March 23, 2008

Check out this great Commonwealth Fund series of articles on preventable hospital readmissions. Right on the heels of conversations about hospital acquired infections (or "healthcare associated infections" as others like to call them), one of the next big quality/cost conversations, we predict, will focus on hospital readmissions that would not occur if care were done right the first time.

Some folks suggest all readmissions are preventable. Our advisers tell us no, and tell us that a whole heck of lot of them are. And the cost implications are serious:

An Agency for Healthcare Research and Quality study of patients admitted to hospital with preventable admissions found 19.4 percent had at least one preventable readmission within six months. The cost of those admissions, which occurred in four states in 1999, was $729 million, or $7,400 per readmission. The numbers are not much better in the commercial population. When PacifiCare Health Systems Inc. reviewed discharge data for its enrollees between 2005 and 2006, it found readmission rates at hospitals ranged from as low as 0 percent to as high as 44 percent, with an average around 10 percent.

And see the case study on how Catholic Healthcare Partners -- by using "heart failure advocates" -- reduced their readmissions rate by five times, with vastly improved outcomes for patients. And here's the rub:

Better management of chronic conditions is likely to lower overall costs to the health system, but current payment policies create few incentives for hospitals to invest in it. In fact, hospitals may lose money by investing in programs that reduce the number of hospitalizations, because most are not reimbursed for their efforts and they stand to lose business as hospital admissions decline.

It's not hospitals. It's this screwed up system that has all the incentives backwards. That's what we've got to change. Sen. Murray's cost containment bill can be the vehicle to put us on the right track, or it can be a missed opportunity. Let's hope it's the former.
John McDonough