One in five Medicare beneficiaries are rehospitalized within 30 days, and one in three are inpatients within 90 days. 90% of these rehospitalizations are unplanned, and a shocking half of those readmitted within 30 days had no outpatient visit billed between hospital discharge and readmission. The cost of these readmissions is estimated at over $17 billion annually. These are findings from a thoughtful article in the New England Journal earlier this month.
Some caveats are important to note. These admissions are by no means all preventable – although it’s striking that the rate of readmission is as high as 23.2% (Washington DC) and as low as 13.3% (Idaho). This variation suggests that we could see big improvements, with substantial cost savings. Outpatient postoperative visits with surgeons are included in global fees, so total visits are understated, although most readmissions of surgical patients were actually for medical, not surgical, problems. This is a Medicare population – so employers thinking about their soaring costs for patients under age 65 need to remember that the mix of disease and the level of social support is different in a non-elderly population. For instance, readmissions for congestive heart failure represented 9.4% of all readmissions, but this diagnosis is relatively rare in the non-Medicare population. The authors note that readmissions can be profitable for hospitals with spare capacity in the Medicare fee for service system.
There is ample evidence we bear a terrible clinical, financial, and social cost from poor transitions in care. This article starts quantifying that cost. There is already a HEDIS quality measure around outpatient visits following mental health inpatient discharges. Maybe we need such a measure for medical and surgical discharges as well.
