How often are patients in your program readmitted in 30 days to any hospital? I know many of you monitor readmission rates back to your own program or facility. But if you examine the patient perspective, how often are patients you discharge being readmitted to any acute care hospital within 30 days?
Given the increasing frequency that the Centers for Medicare and Medicaid Services (CMS) is reporting about readmission rates, I asked my quality director to research our hospital’s data.
As would any reasonable chief medical officer (CMO), I figured we probably had some opportunities for improvement, but overall I felt the numbers were probably fine. Like any hospital I have worked in, we have a core group of patients who return to the hospital frequently. But from a working hospitalist perspective, it didn’t seem to be a problem in our hospital.
So, when the data returned, our initial impressions about the rates were reaffirmed. The overall hospital 30-day readmit rate to our hospital was about 6%. We looked across different payers, socioeconomic groups, discharging services, and diagnosis for areas of opportunity. We found that two populations had slightly higher rates of readmission—congestive heart failure (CHF) and sickle-cell pain crisis—but in general, there were no particular outliers.
I commissioned two quality improvement groups to begin looking at these areas, though I felt pretty good about our data. Although this was not a true all-facility, 30-day readmission rate, we felt it had to be a reasonable proxy for the true rate, which we could not obtain.
We looked to benchmark ourselves because we had no reference for comparison. CMS refers frequently to an approximate 20% readmission rate across the nation; we felt good because our rates were significantly lower. We did some like-facility comparisons, and our rate was still a little better than those facilities, so we continued to feel good.
For those of you who prefer more exact numbers, MedPac reported in June 2007 that 17.6% of admissions resulted in a readmission within 30 days, accounting for about $15 billion in Medicare spending. Further, 6% of admissions resulted in a seven-day readmission rate.
I admit from personal experience that the number CMS touts has always boggled my mind to a degree. This means that almost one in five patients returns to a hospital within 30 days. Having worked in a variety of hospitals and communities, I couldn’t imagine a rate this high. I had never seen patients bouncing back that often.
To me, this simply reaffirmed the hypothesis that healthcare has a serious problem with continuity of care and communication. But this was not my hospital’s problem—we were better than 20%! This was a problem for communities with a poor primary care base or perhaps a community without hospitalists to efficiently take care of inpatients.
But it turns out I fell into a classic leadership trap: thinking we are better than we really are.
Several months ago, I was sitting in a meeting with the quality and patient safety staff, when one of the outcomes managers passed a report to me from CMS. It was the “Pepper Report,” which CMS had begun sending to all hospitals in the past year. One of the key bits of data in this report is the hospital’s 30-day readmit rate. Because CMS is able to gather data from all facilities, this is the true readmit rate—at least for the Medicare population. Ours was approximately 17%. I was immediately deflated.