Readmissions at Florida Hospitals Inching Down, Report Finds

Sep 15, 2016

Hospitals in Florida and most other states have made progress in reducing preventable “readmissions,” the unplanned return of patients within a month of discharge, federal officials say.

A report estimates that 100,000 Medicare beneficiaries – including more than 3,000 in Florida -- were spared a quick return to the hospital last year because of changes the industry has made since 2010.

Florida hospitals’ average reduction was less than most, according to the report from the Centers for Medicare and Medicaid Services.  Florida’s readmission rate was 2.7 percent lower last year than it was in 2010, while nationwide the reduction averaged 8 percent.   The trend affected every state but Vermont.

CMS officials said the data show that cost-constraints and quality-improvement programs initiated by the Affordable Care Act are working.  That helps both patients and taxpayers, they reported on the agency’s blog.

“Not only are readmissions costly, but they are often a sign of poor quality care,” wrote the co-authors, Dr. Patrick Conway, CMS’ chief medical officer, and Tim Gronniger, deputy chief of staff.

A 2009 study estimated preventable readmissions cost Medicare $17 billion a year.

Health News Florida published a special report on the readmission problem in 2009, calling it “revolving door syndrome.”   The analysis said avoidable readmissions reflect the fragmentation of the U.S. health-care system, in which patients fall through cracks.

An unplanned readmission can mean that a patient wasn’t healthy enough to leave the hospital in the first place – insufficiently recovered or harboring an infection.  Readmissions can indicate that patients don’t understand how to take care of themselves, or don’t have access to follow-up care from their doctors. They also may not have family or friends to help them recover.

Florida’s 30-day readmission rate as of last year was 17.7 percent, according to the CMS report.  That was higher than all but six other states. While Florida’s readmission score is down from the 18.2 percent rate of six years ago, the state actually lost ground compared to others because their reductions were steeper.

Florida Hospital Association President Bruce Rueben said in a written statement that even though there is more work to be done, “We are proud of the progress we have achieved.”

Seventy-seven hospitals in the state are part of FHA’s Hospital Engagement Network, which identifies best practices and spreads the word, Rueben said. The next phase of work, he said, is to improve coordination among those who influence after-discharge care:  doctors, pharmacists,  home-health agencies, nursing homes and others.

The reduction in readmissions didn’t happen by chance. The Affordable Care Act, signed into law in March 2010, includes a powerful incentive for hospitals to address the problem – cuts in their Medicare payments if they don’t.

A financial penalty for a too-high readmission rate hurts Florida hospitals more than those in most places,  since nearly half of hospital patients in this state are covered by Medicare.

The readmission problem cropped up as an unintended consequence of a 1985 change in the way Medicare pays hospitals. It had been paying by the day, which tended to encourage extra-long hospital stays. So the agency changed to payment based on the diagnosis. That encouraged hospitals to discharge patients as soon as feasible.  Critics said patients were being released “quicker and sicker.”  

When the private sector adopted managed care in the 1990s and early 2000s, it intensified the pressure on hospitals to speed up discharges. The result was been a dramatic reduction in the average length of stay.

By 2012, a Kaiser Health News report of readmission data showed  that Florida hospitals had both the  best and worst scores in the nation on three common conditions: heart attack, heart failure and pneumonia.

As Health News Florida reported,  Sarasota Memorial and Citrus Memorial in Inverness were the only hospitals in the nation that performed significantly better than average on readmission rates for all three conditions.

At the other end of the scale were eight hospitals in the country that scored worse than average on all conditions. The list included Haley VA Medical Center in Tampa and Florida Hospital in Orlando.  Payment cuts that were to begin in October of that year were going to take $3 million from Florida Hospital because of its score.

Even if the data don’t show it, Florida has been a leader in drawing attention to the readmission rate. FloridaHealthFinder.gov, a project of the state’s Agency for Health Care Administration, offers a  comparison of hospitals’ readmission data and many other measures of quality and cost.

To see it, go to this site and choose the following options in order:  1) hospitals,  2) quality of care …, and 3) overall facility performance.   On the resulting page, find the sorter box, and choose readmission rate. Click on “View Results.” Hospitals are accorded one to three stars, with a lower-than-average readmission rate bringing three stars.