Data Dives

364 Hospitals Have High Rates Of Overall Readmissions, New Medicare Data Show

By Jordan Rau

January 6th, 2014, 5:00 AM

Medicare’s new comprehensive measure of hospital readmissions shows that at least 20 percent of the hospitals in Illinois, Maryland, Massachusetts, New Jersey, New York and Rhode Island have higher rates of patients returning than the national average.

Colorado, Hawaii, Idaho, North Carolina, Oregon, South Carolina, Utah and Washington led the states with the highest proportion of hospitals with low readmission rates. In those states, between 13 and 16 percent of hospitals came in below the national average, which was 16 percent of Medicare patients, the data show.

Since 2008, Medicare has been tracking hospital readmission rates and publishing those for three common ailments. In December, the government expanded its disclosure by publishing hospital rates of Medicare patients of all diagnoses who returned within a month for unplanned reasons from July 2011 through June 2012. At 364 hospitals, or 8 percent, patients returned more frequently than did patients at the average hospitals. Some of these facilities are among the most revered in the country, such as the Cleveland Clinic and Duke University Hospital in Durham, N.C.

Patients at 315 hospitals, or 7 percent of those rated across the country, were readmitted at a lower rate than the national average. They included Baylor University Medical Center in Dallas, California Pacific Medical Center in San Francisco and Intermountain Medical Center in Murray, Utah. The rest of the nation’s hospitals were rated as average.

The KHN chart at the bottom of this story lists all hospitals that did either better or worse than average on this measure, known as hospital-wide all cause unplanned readmissions.

The all-cause readmission rates are particularly significant because the Medicare Payment Advisory Commission (MedPAC), which advises Congress, has encouraged lawmakers to use this measure when determining financial penalties for hospitals in the Hospital Readmission Reduction Program. Medicare is currently fining 2,225 hospitals for excess readmissions for heart failure, heart attack and pneumonia patients. (The full penalty list is in this KHN interactive chart, and Medicare publishes the underlying data here.)

The number of cases of each of these three conditions for many hospitals is quite small, making it hard for the government to make accurate assessments of their readmission rates. Half of hospitals have 70 heart attack patients or fewer over a three year period. Nine out of 10 hospitals would have at least 1,100 cases of any kind over three years, making calculations more accurate, MedPAC said.

The hospital industry and some independent researchers have expressed reservations about all the readmissions measures. They say they do not reflect that some hospitals end up saving lives by being more aggressive in readmitting patients at early signs of trouble. They also complain that hospitals with large proportions of low-income patients often have higher readmission rates because those patients often don’t have the money for follow-up care and are more likely to lack their own primary care physician. Finally, while Medicare does take the degree of patient sickness into account when judging hospitals, academic medical centers say that the government analysis isn’t refined enough to fully notice which patients are sicker than others with the same ailment.

Some cities had particularly large numbers of high readmission hospitals, the data show:

Chicago: 19 hospitals including Northwestern Memorial Hospital, Rush University Medical Center and the University of Chicago Medical Center.

Brooklyn: 11 hospitals including Brookdale Hospital and Medical Center, Kingsbrook Jewish Medical Center and New York Methodist Hospital.

Philadelphia: 10 hospitals including Einstein Medical Center, the Hospital of the University of Pennsylvania and Thomas Jefferson University Hospital.

Baltimore: Seven hospitals including The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, MedStar Good Samaritan Hospital and the University of Maryland’s Medical Center and Midtown Medical Center.

Manhattan: Seven hospitals including Beth Israel Medical Center in Manhattan, Lenox Hill Hospital, New York-Presbyterian Hospital and NYU Langone Medical Center.

Boston: Five hospitals: Beth Israel Deaconess Medical Center, Boston Medical Center, Brigham and Women’s Hospital and the Brigham’s Faulkner Hospital, and Tufts Medical Center.

Los Angeles: Four hospitals: California Hospital Medical Center, Hollywood Presbyterian Medical Center, Olympia Medical Center and Ronald Reagan UCLA Medical Center.

Miami: Four hospitals: Jackson Memorial Hospital, Kendall Regional Medical Center, University of Miami Hospital and Westchester General Hospital.

Out of all cities, Oklahoma City had the most hospitals with lower than average readmissions rates, with four scoring better than average.

Here is the full list of hospitals with the best and worst records in all-cause readmissions:Hospitals With Best And Worst Overall Readmission Rates

20 Responses to “364 Hospitals Have High Rates Of Overall Readmissions, New Medicare Data Show”

  1. pam says:

    In my opinion, any hospital that is rated “Worse” needs to be shut down immediately. They should not be allowed to open until that address all of the reasons why they have such a terrible rating. If the board of health can shut down wholesale and retail food businesses, then the board of health should be able to shut down the worst hospitals as unfit for humans.

  2. Daniel says:

    Republicans want to repeal Obamacare and replace it with nothing. Republicans want to take us back to a time when hospitals were not rated and consumers were left to suffer with corrupt hospital administrators and a corrupt hospital industry. I wonder how many of those patients that were re admitted actually died as a result? I wonder how many hospital administrators should be indicted for wrongful death or manslaughter? Republicans keep saying that America has the best healthcare in the world. Do we? Just because we pay twice as much as any other country? Americans pay twice as much for healthcare as any other nation in the world. For what? High rates of hospital readmissions? We need to ask ourselves why in the world would anyone listen to Republicans about running a healthcare system. Like Pam says, the hospitals rated “Worse” need to be closed and investigated by the board of health. Above all, we need to stop taking advice from Republicans about healthcare. Republicans protect the hospitals, not consumers. Republicans are not to be trusted.

  3. Wendy says:

    If we didn’t pass the Affordable Care Act (ACA), we would never have studies showing the above data. It is exactly why Republicans fought the ACA tooth and nail. Republicans didn’t want the truth to be told. Republicans wanted to keep consumers in the dark. If they could, Republicans would return us to a healthcare system that is not transparent and filled with secrets and mystery. Republicans are cockroaches. They run and hide with somebody turns on the kitchen light! Republicans should be ashamed.

  4. killroy71 says:

    The ACA helps fund this activity, but CMS started tracking data in 2008, before Obama was even elected.

  5. Ann says:

    Are there any common denominators between “worse” ratings and hospital practices/policies? What about commonalities in patients’ lifestyle choices, economic conditions, and adherence to discharge orders? We all know that hospitals cannot watch patients 24/7 after discharge. What about patients who return to unhealthy diets and sedentary lifestyles despite education and doctors instructions? What if patients refuse or forget to take their medications? (Doctors can prescribe medications but they can’t make them swallow the pill.) When it comes to Medicare patients, we’re often talking about people who often have multiple health problems, frailties, bodies reacting naturally to aging and sometimes a lifetime of poor choices. When my elderly mother was discharged from the hospital, she was discharged primarily due to Medicare policies about number of days they will cover inpatient hospital care. From there she went to a rehab center. In that instance, she wasn’t readmitted but if she had been, who is to say it was the hospital’s fault, the rehab facilities, her lifestyle choices or Medicare rules that might not be based on good evidenced based science? Good medical care is a combination of good science, the art of patient care that comes through experience and a patient’s willingness to take some responsibility for their health. Even in the best of circumstances, you may not get the outcome desired because human bodies aren’t machines. Decisions about patient care should be determined by patients, their healthcare team and their families if the patient is incapacitated. It seems to me that the government wants to be in the driver’s seat when it comes to patient care but they want to scapegoat hospitals and physicians if outcomes aren’t optimal. For those who think any hospital with a “worse” rating should be immediately shut down, I would ask you to think about the consequences of lack of access to care period. I live in a rural area where the closest hospital is a 30 mile drive. If that hospital closes it’s even farther. In urban areas, closing hospitals means less choice. When you end up with a hospital monopoly with a single payer system, that’s also a monopoly, how good do you think your care is going to be then? Think people!

  6. EILEEN says:

    It would behoove CMS to look at the correlation between the hospitals with the highest rates of readmission and the socio-economics of the community they serve. We are all aware of how socio-economics, including language barriers, income, insurance, housing and employment affect one’s overall health and well being. As well, what are the assets of the community to support an individual once they do leave the acute care setting, and how are they supported? There’s more to the story that is being overlooked, pointing fingers at the hospitals. People are in the hospital for a short period of time and in community much, much longer. Look there first.

  7. Dave says:

    Defending bad hospitals is wrong under any circumstances. It’s up to consumers to raise hell. If you allow a bad hospital to exist in your community, you deserve what you get. Why would any sane person use a hospital rated “Worse”? If you know a hospital is rated “Worse”, you deserve what you get. It’s up to consumers to contact the board of health in their community to insist on quality and performance. Either a hospital performs to a national standard or the get shut down. I would never knowingly allow my family to use a hospital rated “Worse”. I don’t care if I have to drive to another hospital. Regardless how far I need to drive. You would be insane to knowingly use a bad hospital. We have been in tha dark for top long. It’s about time hospitals are subject to scrutiny.

  8. reggie says:

    Dave is correct. It’s our own fault. The consumer has tolerated poor hospitals for far too long. The sad part is, there was no way of knowing which hospitals were “Worse”. Up until the Affordable Care Act (ACA) in 2010, hospital and doctor reporting was sketchy, at best. Like doctors, hospitals didn’t compete on a level playing field. Hospitals covered for each other, just like doctors. Quack doctors and bad hospitals were covered up. The only way you would know about how bad things were is to have a close friend or a relative in the medical industry and promise them to never reveal who they are or what they told you. Before the ACA, it was all rumors. With reports like what we see above, how could anyone knowingly use a hospital rated “Worse”. You are risking your life by using such a hospital.

  9. Dr. Lee G says:

    It would seem to me that half the hospitals in the country have admission rates greater than the national average. That’s what an average is. The underlying assumption that half the hospitals in the country provide substandard care. According to CMS, the only acceptable outcome is to have 100% of hospitals’ readmission rates below the national average. Not possible. That’s not proof of substandard care, however.

  10. Unfortunate to see Chicago on the list of cities with high readmission rates. That’s definitely something we need to work on.

    I do know that this is an issue that many hospitals are actively working to address. In fact, Henry Ford has a contest among startups to find innovative solutions to reduce excess hospital readmissions.

  11. David says:

    Em, do people understand what an average is?

    To explain to those who don’t – about half the hospitals will be above the average, and about half below.

    It is not mathematically possible to have all hospitals above average.

    It is far too simple a measurement to be taken in isolation.

  12. While the reasons for these readmissions need to be assessed, the fact that such statistics are available is a major step forward. Canada has long had a fully taxpayer-funded healthcare system, yet it has no similar figures on a national basis that are easily accessible. Many argue that Canada has one of the least accountable healthcare systems of all major G8 countries insofar as hospital safety is concerned.

    Accountability is the key to better patient safety. It only works when patients and families are informed about performance – - or the lack of it.

  13. JoAnn says:

    This is a complex issue that can’t be solved with a simple ‘shut them down’. If we shut down hospitals based on readmission rates we would be closing half the hospitals in the U.S.
    Of note there are some stellar medical centers on that list which proves to me that all hospitals are struggling with this issue even those that have more ample resources than others.
    In healthcare we always think if we had more money we could do a better job, I think this list proves that to be incorrect. We need to get into the communities we serve and educate people to have a primary care doctor, to not use the emergency room as your primary provider, to have yearly physicals and practice preventative medicine.
    For those of us that have doctors we think this is simple, but it is in fact a complex issue that faces many people in this country. For generations they have not taken care of themselves and only went to doctors in an emergency. We have to educate our communities to get healthy.
    Whenever any politician starts to talk about soda or obesity the propaganda machine starts because some industry will suffer if people don’t gorge themselves, I challenge these industries to create a better product instead of using their resources to destroy a good idea.
    So this is our next phase in healthcare, and it’s a good phase. We all need to be more accountable, but in the meantime instead of complaining, volunteer to help your community to get healthier and the readmission problems will greatly decrease.

  14. K says:

    Thank you David, for identifying the mathematical flaw in this entire debate. To all the above who’ve just advocated for shutting down the worse HALF of our nation’s hospitals, maybe stop and think for a moment about what that’s going to do to healthcare access, (not to mention how that will affect unemployment rates). OF COURSE half are going to be worse than the other half. It’s a single popuation of hospitals, and we’ve rated all of them on the same scale. That’s the point.
    If we rated all restaurants in the nation in terms of instances of food poisoning, there’d be a ” worse off” half and a “better” half, but I wouldn’t suggest that we should shut down every single restaurant that falls below that national average.

    …Some of these comments are making me really proud to be a cockroach :) .

  15. Coleen Niemann says:

    first link in article is driving to wrong URL.

  16. Harry says:

    “…Some of these comments are making me really proud to be a cockroach”

    If the shoe fits…..

  17. Harry says:

    Not surprised.

  18. elliot says:

    Wait, so this story says that there are hospitals that perform worse than average and ones that performed better according to one metric. Groundbreaking.

  19. Rob says:

    The Better and Worse means that there is a statistically significant difference from the norm. There are only 364 listed here out of the 3,500 hospitals whose readmission rates were published with the FY14 IPPS Final rule so just over 10% of the hospitals are significantly above or below the average.