A hospital stay, especially for seniors and other Medicare recipients, can be a costly proposition, one that becomes even more expensive if the patient has to return to the hospital immediately after being discharged.
One element of the sweeping Affordable Care Act, the “Obamacare” law passed by Congress in 2010 and upheld recently by the US Supreme Court, aims to reduce those costs by penalizing hospitals whose readmission rates for some conditions are deemed too high.
Under the law, hospitals where an excessive number of some Medicare patients must be readmitted within 30 days of an initial stay will lose one percent of their funding from the Medicare program, an amount that rises to two percent in 2014 and three percent in 2015 for hospitals remaining out of compliance; some other Medicare payments, however, would remain untouched.
For several months hospitals and other medical care providers have been preparing for the new regulation through programs designed to offer more outpatient support and by other means to bring readmission rates down. Newark's University Hospital is using a $300,000 grant to connect patients with health care professionals who provide advice on how to avoid return stays in the hospital.
Experts point to a variety of factors affecting readmission rates. In some instances, patients may be unable to afford co-pays for necessary medications. Language barriers can also make providing ongoing care after a discharge from the hospital difficult. Literacy and poverty rates play a role as well.
For many New Jerseyans, simply maintaining a healthy regimen can be a challenge. In some areas, patients find it difficult to purchase fresh fruit and vegetables because they live far from full-service grocery stories and must instead rely on food items high in sodium and sugar bought at nearby convenience stores, said Aline Holmes of the New Jersey Hospital Association.
“If they didn’t have good access to transportation, asking them to take buses and make four or five bus transfers to shop at the closest real grocery store was not realistic,” Holmes said in an email.
“No one knows exactly what percentage of hospital readmissions is avoidable, but many are,” Dr. Andrew Miller said in a statement. “Ending up back in the hospital is not good for patients and it costs a lot of money. Reducing readmissions is a win-win for patients and for Medicare.”
Miller is the medical director of East Brunswick-based Healthcare Quality Strategies, Inc., which has been charged with helping improve the quality of care for the state’s Medicare patients.
Healthcare Quality Strategies has compiled data comparing readmission rates by county for the years 2008 through 2011. Overall, the data show that New Jersey hospitals had a readmission rate of about 20 percent, higher than the national average of about 18 percent. But there were large differences among individual counties: affluent Hunterdon had a rate of just 16.6 percent, the lowest in the state, versus Hudson, which at 24.6 percent had the highest readmission rate.
Bergen, Union and Somerset counties were all close to the state average, while Essex and Salem were closer to the high end of the scale, not far behind Hudson.
The variance in percentages says as much about the nature of the of the populations served as it does about the hospitals caring for them, said the New Jersey Hospital Association’s Holmes.
“I think it does make a difference, especially if you look at readmission rates for Hunterdon and Sussex counties, which look population-wise more like Utah or Kansas, where readmission rates are lower, and compare those rates with Hudson and Essex, [then] there’s room for discussion around the impact of cultural, religious and linguistic differences,” Holmes said.
Hospitals with high readmission rates will not necesarily see their Medicare cut. Various factors, such as general health of the patients served, will be considered in detrmining whether the hospital's readmission rate is too high.
A list of affected hospitals should be available in the next several weeks.