The need for broad improvements in systems of care, of which discharge planning and care coordination are only two components, is evident in the strong association found between general health system factors and readmission rates. We found a robust relationship between regional inpatient intensity of care provided to Medicare beneficiaries and the risk of readmission; that is, in places where there was a greater tendency to use hospitals as the site of care, patients were more likely to be readmitted, irrespective of illness levels. This confirms other research underscoring the importance of primary care systems in reducing avoidable hospitalizations and the influence of local bed supply on overall admission rates. When a readmission is prevented, is the bed unfilled, or is it filled with another patient? If so, could that patient be cared for better and with less cost outside of the hospital? Under current payment models and care systems, the incentive is to fill the bed. In the absence of other interventions, reducing readmission rates may have no impact on total per capita inpatient days and costs within a community. This underscores the importance of aligning efforts to reduce avoidable readmissions with other policy and payment initiatives, such as global payments and accountable care organizations. Efforts to monitor improvements in care coordination and transitions need to be coupled with broader surveillance of patient populations and cohorts, so that the promise of better care for patients leaving the hospital is also reflected in improved outcomes and lower costs for the population as a whole.
Links to the report and an interactive map are here.