More bad news for Medicare’s hospital readmissions measure

Jordan Rao reports:

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. […] 

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.

The Annals of Emergency Medicine paper by Rising et al. is here. The JAMA one here. I have not read either, yet.

Is there a good reason not to count ED visits along with readmissions? Recall that readmissions are down. To what extent can that be explained by an increase in ED visits that don’t result in an admission? I’m not saying that’s what’s happening, but do we know?

@afrakt

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