Hospitals are not getting the job done when it comes to reducing readmissions and improving care coordination for Medicare patients. A report from the Dartmouth Atlas Project shows that approximately one in six Medicare patients end up back in the hospital within a month after discharge. Little progress has been made over a five-year period and, in fact, readmission rates for some conditions have increased nationally and for many regions and at some hospitals, including some elite academic medical centers.

In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers found major variation in 30-day readmission rates across regions and academic medical centers. Key findings include:

  • Overall readmission rates following surgery were 12.7 percent in both 2004 and 2009, while readmission rates for medical conditions rose slightly from 15.9 percent in 2004 to 16.1 percent in 2009.
  • Readmissions decreased after medical discharges in 11 regions, with Bismarck, N.D., experiencing the largest decrease, from 16.3 percent in 2004 to 14 percent in 2009. They increased in 27 regions, with Aurora, Ill., experiencing the largest increase, from 14.3 percent in 2004 to 18 percent in 2009.
  • Readmission rates after surgeries also varied, with 28 regions experiencing a decrease, most notably in Elyria, Ohio, which decreased from 19 percent in 2004 to 15. 2 percent in 2009. Rates increased in 18 regions, with White Plains, N.Y., experiencing the largest increase, from 13 percent to 17.4 percent.
  • Among patients who were released to go home from the hospital after medical treatment, 42.9 percent had a primary care visit within two weeks, which Dartmouth notes can be an important opportunity to check on the patient's progress and adherence to medication regimens and to review concurrent illnesses and health risks. Among patients who were released to go home after surgical treatments, 21.8 percent had a primary care visit. In this case, follow-up with a surgical clinician makes more sense, and rates of primary care follow-up after surgical discharge can be low even if patients are receiving excellent care from surgeons, Dartmouth notes.
  • Readmission rates for acute myocardial infarctions decreased from 19.4 percent in 2004 to 18.5 percent in 2009. Rates for congestive heart failure, pneumonia and hip fractures barely changed.

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