Section 3025 of the Affordable Care Act that became effective Oct. 1 requires that the Centers for Medicare & Medicaid Services , CMS, make reduced payments to participating hospitals with excessive 30-day readmission rates for discharges. Studies published in the Jan. 23 Journal of the American Medical Association reveal that while readmissions within 30 days of previous hospital discharge remain frequent, those readmissions are now more frequently due to diagnoses different from the original hospital stay.
Why Short-Term Hospital Readmissions Are Important
In simply practical terms, a readmission to the hospital within a short period of time for the same diagnosis raises questions of the quality of care provided during the initial hospital stay. Frequent or repeated readmissions for the same diagnosis brings into question the appropriateness of discharge in the first place and the quality and completeness of discharge-planning. Beyond the quality of health care and discharge, the fact is that such readmission are costly to the insurer financially and to the patient in terms of quality of life and potential for a decline in health.
Hospital Readmissions Remain Frequent for Medicare Beneficiaries
Study authors found that since Oct. 1 readmissions for Medicare beneficiaries remain high for three diagnoses: heart failure, pneumonia and acute myocardial infarction, MI. Eighteen to 25 percent of Medicare beneficiaries with one of the three diagnoses were readmitted to the hospital within a 30-day period.
Nearly two-thirds of short-term hospital readmissions for people initially diagnosed with one of these three diagnoses occurred within the first 15 days of discharge, the other one-third within 30 days.
Dr. Mark Williams of Northwestern University Feinberg School of Medicine in Chicago explained to MedpageToday.com that the study's findings aren't surprising in that previous research by the same team revealed the complexity of medical issues faced by Medicare beneficiaries with any of the three diagnoses, medical complexities that complicate medical care, discharge planning and prognosis.
Implications of Medicare Readmission Reduction Program and Reality of Medical Complexity of Medicare Beneficiaries
While many of the Medicare beneficiaries readmitted to the hospital with an initial diagnosis of pneumonia, heart failure or acute MI were readmitted for the same diagnosis, more were readmitted for other diagnoses, often associated in some manner with the initial condition requiring hospitalization.
Harlan Krumholz, MD, Yale University School of Medicine and one of the JAMA study authors, suggests that hospitals should take into account the oft-repeated diagnoses that require such short-term readmission when developing future interventions and treatment modalities in an effort to stave off such readmissions.
- Health Care Policy