Readmissions Facts

Readmissions are falling fast thanks to the hard work of America’s hospitals to improve care, provide better discharge instructions to patients and partner with patients and others in their communities to coordinate care after they leave the hospital (Medicare Rules Reshape Hospital Readmissions, December 2). However, the Wall Street Journal’s analysis questions that these gains have been fully achieved. 

Here is what the numbers show. Between January 2012 and November 2014, hospitals participating in the American Hospital Association Partnership for Patients initiative avoided 65,022 readmissions generating health care savings of nearly $575 million. Additionally, an analysis in a 2014 CMS peer-reviewed journal did not find evidence to suggest the drop in readmissions rates was the result of increases in either emergency department visits or observation stays as CMS stated in the article.

It is no coincidence that the increase in observation services occurred with the advent of the Recovery Audit Contractors (RAC) program.  Too often, the medical judgment of treating physicians was second-guessed by RACs, which could evaluate a beneficiary’s admission in hindsight, looking at the entire medical record rather than only the information that was known to the physician at the time of the admission. Fortunately, CMS has moved to curtail the egregious behavior of the RACs. 

However, there is always more work to be done but the Centers for Medicare and Medicaid Services (CMS) own data show we are headed in the right direction.  That’s good news for patients.