OASIS Alert

Don't expect providers' interests to coincide.

Rehospitalization is frequent, costly, and associated with gaps in follow-up care, a new study shows. Your close monitoring can make a difference.

Despite intense efforts in many home health agencies, rehospitalization rates remain high.

And the national average even increased on Home Health Compare in 2008.

As many as one-fifth of all Medicare patients are readmitted within a month of being discharged, and one-third are rehospitalized within 90 days, according to a study of Medicare claims data from 2003 to 2004 published in theApril 2 New England Journal of Medicine.Medicare payments for unplanned rehospitalizations in 2004 accounted for about $17.4 billion of the $102.6 billion in hospital payments from Medicare, report authors Stephen Jencks,MarkWilliams, and Eric Coleman in Rehospitalizations Among Patients in the Medicare Fee-for-Service Program.

The most frequent reasons for hospitalization were heart failure, pneumonia, psychoses, and chronic obstructive pulmonary disease.

Two factors the study pointed out may be of special interest to HHAs:

1. Lack of adequate follow-up. Half the patients who returned to the hospital within 30 days of undergoing treatment other than surgery apparently did not see a doctor before they went back to the hospital.

There was no associated bill for an outpatient visit for 50.1 percent of the patients who were rehospitalized within 30 days after discharge and for 52.0 percent of those who were rehospitalized for heart failure within 30 days after discharge, the study reported.

2. Significant geographic differences. When you look at the list of states arranged in order of rehospitalization rates, the rehospitalization rate in the five states with the highest rates was 45 percent higher than it was in the five states with the lowest rates.

Hidden trap: Under the current system, reducing the number of returning patients can work against the financial interests of a hospital needing to fill empty beds. About one in four of the nation's hospitals derive 25 percent of their admissions from return visits by patients, according to the study.