Also highlighted for scrutiny are 92 academic medical centers, which Goodman and colleagues said have somewhat higher ranges of variation. For example, the University of Connecticut in Farmington went from 13.1% to 17.9% and the University of Medicine and Dentistry Hospital of New Jersey's readmission rates rose from 18.3% to 22.3%.
Hospitals must take action on two fronts, Goodman said. One is to improve discharge planning and care coordination, and the other is to make sure patients have the medications they need and the means to have prescriptions filled and that follow-up appointments are made.
The latest Dartmouth report illuminates the same sort of regional practice variation trends that have distinguished many of its other research projects, for example, on use of palliative care at the end-of-life care and regional and racial variation in primary care.
Goodman said that those parts of the country with high readmission rates tend to have "system factors" or patterns of care that rely on hospitals as the primary site of care. Parts of the country that tend to have more patients hospitalized are generally the same places that also experience high readmission rates."
On Aug. 5, the Centers for Medicare & Medicaid Services released the names of 4,600 hospitals and their readmission rates for a three-year period that includes two of the ones that will be used for the Medicare penalty calculation. Hospitals said to have worse than national average rates in one, two or three disease categories found themselves going into defensive mode and scurrying to make changes to their care processes.
Now, these same hospitals await final determination of whether they will be fined up to 1% of their Medicare reimbursement under provisions of the Affordable Care Act, which evaluated each facilities readmission rates between July 2008- June 2011. Even as Medicare will cut up to $850 million in payments to outlier hospitals, several states such as Massachusetts and New York this year launched their own financial penalties for hospitals with higher rates of readmissions of patients covered by Medicaid.