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Hospitals ranked by readmission rates

Print | Comments () Posted by Chelsea Conaboy May 2, 2011 10:00 AM

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By Chelsea Conaboy, Globe Staff

My father's parents are remarkable: both in their 90s and in good health, for the most part. Still, they see a lot of doctors. My Dad often goes along, asking questions and making sure they understand the doctor's orders. I'm glad for that. Navigating the health care system can be difficult at any age.

Graphic See the readmission data

A lot of seniors don't have someone like him. And, even if they do, their needs are so great that their family may be overwhelmed. Getting the care they need and the appropriate follow up, particularly after an event serious enough to require hospitalization, is a challenge. Often, they end up returning to the hospital again and again. The cycle compromises their health and costs a lot of money -- about $12 billion in annual Medicare costs that could be avoided if the system worked better, according to a federal advisory panel.

The US Department of Health and Human Services has made reducing hospital readmissions, particularly among people 65 and older, a top priority for improving quality and cutting costs. Last month, the agency released a state-by-state list of hospitals ranked by the percentage of Medicare patients who were treated for one of three key conditions -- heart attack, heart failure or pneumonia -- discharged, and then hospitalized again, for any cause, within 30 days.

Two Massachusetts hospitals had among the worst rates in the state for all three categories: Beth Israel Deaconess Medical Center in Boston, and St. Elizabeth's Medical Center in Brighton, part of Steward Health Care.

Hospitals are paying more attention to readmission rates, in part because they could soon affect their bottom line. Starting in 2013, those with the highest rates could be docked Medicare payments. The health and human services department has pledged $500 million to help hospitals partner with community-based organizations that help patients make the transition from a hospital bed to their home.

“The care model is fragmented," said Dr. Kenneth Sands, senior vice president for health care quality at Beth Israel Deaconess. "Hospitals do their piece, and they're paid for it. Community organizations do their piece, and they’re paid for it. And there has not, until recently, been a joint incentive to do better.”

His hospital is talking with Springwell, a home care organization that operates in eight communities west of Boston, about submitting an application for the federal grant money. Sands said rates there were high in part because the facility also has a low mortality rate -- which means it was discharging more very ill patients that may have died elsewhere. But he said, every hospital has room to improve.

St. Elizabeth's is taking action, too, said Dr. John O. Pastore, a cardiologist and vice president for medical affairs. When Dr. Ralph de la Torre became head of Steward's predecessor, Caritas Christi, three years ago, he made reducing readmissions a priority, Pastore said.

The hospital system is working with its own home care services to improve communications. In June, it will reorganize how it uses medical residents. Instead of circulating through the hospital's three medical floors, they will be assigned to just one so that patients and nurses can find a doctor more readily if they have questions at discharge.

Pastore said he's confident the numbers will get better when they're updated next.

“These data are taken very seriously," he said. "We’re aware of them. We know where they came from, and we know we’re going to get better.”

The list was based on data from 2005 to 2008. The Centers for Medicare & Medicaid Services is working on an updated version that ranks hospitals based on readmissions for all conditions. For now, check out the list and see how Massachusetts compares to other states.

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About white coat notes

White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at cconaboy@boston.com. Follow her on Twitter: @cconaboy.

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