June 23, 2010

A recent report by the Office of Statewide Health Planning and Development (OSHPD) called Readmissions for California Hospital Patients 2005-2006, reveals that 36 percent of patients admitted to California hospitals in 2005 returned for readmission within a year. And one third of those returned within 30 days.

“It definitely [emphasizes] the importance of teamwork at the point of discharge,” said Mary Tran, a research scientist with OSHPD and author of the study. She stressed the importance of making sure there is adequate support at home for the patient and working with the family. “If doctors would invest a little more time in that, it would probably reduce the readmissions,” she said.

Soon a benchmarking tool will be available for hospitals to determine how they are performing on reductions of hospital readmissions. The California Hospital Assessment Reporting Task Force (CHART), is planning to make hospital–specific readmission data available either in November of this year or in February of 2011, said Debby Rogers, Vice President of Quality and Emergency Services with the California Hospital Association.

CHART is funded by the California HealthCare Foundation and is made up of hospitals, government entities, insurers and health plans, clinicians, employers and the business community, labor unions and consumers. Together they have developed 71 performance measures for hospitals and created a hospital report card available at CalHospitalCompare.org.

Rogers said the OSHPD report is valuable, “It’s a great report it lays out the landscape, showing conditions that are likely to be causing readmissions,” she said. But she questions OSHPD’s approach of looking at a whole year’s worth of data and said the study doesn’t differentiate between readmissions that are related to the original hospital admission and those that are totally unrelated.

Tran agreed that’s a very important question, but said her organization didn’t have the resources to make those differentiations and sometimes deciding if two hospitalizations are related can be difficult, and it involves looking at many aspects of the patient’s condition.

One thing that’s clear is that hospital readmissions are a heavy expense for public and private insurers. The OSHPD report states that in 2005-06 readmissions added $31 billion to the charges billed to Medicare, amounting to 50 percent of charges for California hospital services. During that same period readmissions added almost $10 billion to Medi-Cal, resulting in 49 percent of the Medi-Cal total.

Insurers are conducting their own studies and initiatives to curb the rate of return visits to the hospital. This month America’s Health Insurance Plans released a publication called “Innovations in Reducing Preventable Hospital Admissions, Readmissions and Emergency Room Use.”

One of the efforts highlighted in that report is an initiative by Aetna Inc. Aetna’s Managed Care Advantage members who participate in the Transitional Care Model program get home visits and phone calls from nurses. The nurses can remain in contact with patients for several months, may accompany patients to doctors’ visits and coordinate care if a patient has several physicians, to make sure there are no adverse medical interactions. Aetna reported that this pilot program is saving $439 per month per member.