Short Takes On News & Events

Medicare Effort To Cut Readmissions Isn’t Counting Patients Who Come Back To ER

By Jordan Rau

April 9th, 2013, 2:15 PM

A study published Tuesday says Medicare may be missing factors that lead to post-hospital health problems because it isn’t counting many discharged patients who come back to the emergency room but aren’t admitted.

The study in Annals of Emergency Medicine looked at 11,976 patients discharged from Boston Medical Center, the largest safety net hospital in New England, in the first half of 2010. The total number of impatient discharges during the period studied was 15,519, including patients who were readmitted more than once.

The researchers found that a quarter of those discharges resulted in at least one emergency department visit within a month after the patients left the hospital. But 54 percent of those visits to the emergency department (ED) did not lead to a readmission and thus would not have shown up in the statistics when Medicare calculated the hospital’s readmission rate.

“By limiting the focus of hospital readmissions measurement to only inpatient-to-inpatient events and omitting ED visits shortly after hospital discharge, researchers and policymakers may be missing a substantial source of return-to-acute health care use that is managed solely in the ED,” wrote the researchers, led by Dr. Kristin Rising of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “A comprehensive approach to understanding factors contributing to subsequent health care use in the post-hospital discharge period would include a closer look at patient use of the ED occurring within 30 days of hospital discharge.”

Similar results were found in a study published in January in the Journal of the American Medical Association.  That study calculated that for every 1,000 discharges, there were 98 treat-and-release visits to the emergency room.

Since October, Medicare has been financially penalizing hospitals with higher than expected readmission rates of elderly patients suffering from heart attacks, heart failure or pneumonia. Medicare is reducing reimbursements for 2,213 hospitals, with 276 of those losing the maximum allowed under law, 1 percent of their regular payments.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

One Response to “Medicare Effort To Cut Readmissions Isn’t Counting Patients Who Come Back To ER”

  1. sencha says:

    Thank you for surfacing this regulation and reporting flaw.
    The “negotiating” between the special interest groups may make the under reporting problem much worse than even this new research suggests.
    This is due to the long standing health plan mandate to require hospitals to use the patient admission classification, “admit -to- observation” or “admit- for- observation.”
    Under the health plan guidelines governing reimbursement to acute care hospitals for inpatient admissions, patients who the hospital believes need admission for overnight nursing care on an inpatient unit but do not have symptoms intensive enough to meet the health plan’s criteria of inpatient admission must be classified in the observation status.
    Under this gray area hospital admission event, the hospital can not bill for a highly lucrative inpatient admission but will be paid only a small out patient daily care fee. Initially this was thought to reduce health plan payments to providers but now with the Medicare readmission monitoring and penalty program underway, this observation status is a method available to the hospital to manage the risk of penalty for preventable readmission.Steps to lower the classification of a readmission event may go a long way towards lowering the hospital’s preventable readmission penalty.

    Under this classification system, when the inpatient returns after an acute hospitalization and needs more than ED treatment, then the attending physician has the option to admitted that patient from the ED to an acute care inpatient unit
    for a 48 to 72 hour overnight ‘observation stay.” Under accreditation standards, this patient must receive the same standard level of care that all inpatients on that unit receive, but that two to three night “observation stay” is seldom reclassified as an inpatient admission. With the preventable readmission penalty looming chances are that observation stay event will remain classified by and billed the hospital as observation.