Health, Doctors and Common Sense

More than one in every three people hospitalized in California winds up being readmitted within a year – a revolving-door pattern that adds billions of dollars to health care costs, according to state data.

Many of those readmissions could have been avoided, said researchers at the Office of Statewide Health Planning and Development, which issued a study Monday using 2005-06 data.

"Readmissions are an important issue because they are expensive, can involve additional difficulties for patients and caregivers, and often can be preventable," said Dr. David Carlisle, the agency's director.

While the report did not include a hospital-by-hospital analysis, researchers found that hospitals in the Los Angeles area had the highest rate of readmissions (1.73 per person per year), while hospitals in the state's mountain counties had the lowest (1.49).

The Sacramento Valley region had the second-lowest rate of readmissions among the six areas studied by the state – 1.53.

The study found that 1.7 million people were admitted to California hospitals in 2005. Within a year, 36 percent of them came back.

With mounting pressure to contain health care costs, the agency hopes its report will spur discussion not only about medical bills but about the quality of patient care.

Already, the federal Centers for Medicare and Medicaid Services is looking for ways to cut costs – including the possibility of reducing government reimbursement to hospitals with high rates of readmissions.

The state researchers found that readmissions added $31 billion to the charges billed to Medicare, amounting to half of what the federal insurance program pays for all hospital admissions in California.

Readmissions accounted for 49 percent of Medi-Cal hospital costs, accounting for nearly $10 billion in expenditures.

Patients with private insurance had a lower rate of readmissions – and also paid less for their initial hospital stay.

The study's lead author, Mary Tran, declined to offer an explanation, saying certain findings were ripe for further exploration.

"This is just a starting point," said Tran. "The whole purpose of this was to provide a broad background and understanding of readmissions in California. … We wanted to see the lay of the land."

For its report, OSHPD culled hospital discharge data for 2005, the latest year mortality information was available, and tracked patients into 2006 to gain insight into readmissions.

Among the other findings:

• Older patients were more likely to be readmitted, but the average number of readmissions was higher for younger adults.

• Those on Medicare and Medi-Cal were readmitted more frequently.

• Readmission was more likely for patients initially admitted for ailments stemming from chronic conditions, such as heart failure, emphysema and kidney failure.

Over the years, cost-conscious employers and insurers have emphasized prevention and wellness programs to cut down on chronic ailments. And hospitals have tried to become more diligent in keeping patients out of the hospital.

"Research shows that efforts to educate patients and follow up with them shortly after returning home can help prevent those patients from needing to go back to the hospital. This has serious implications for overall health outcomes and the cost of health care for all Americans," said Patrick Johnston, president of the California Association of Health Plans.

Last year, Sutter Health put in place new patient protocols designed to improve follow-up care and reduce the risk of patients needing further hospitalization.

As part of the health system's Transitions of Care program, registered nurses periodically check on recently discharged patients via telephone.

"We've been very aggressive so our patients don't fall through the cracks," said Michael Avriette, the utilization management executive for Sutter Health's Sacramento Sierra Region.

He noted that Sutter's rate of readmissions for Medicare patients within the first month of discharge is between 7 percent and 9 percent – less than half the national average of 18 percent.

"Readmissions are expensive," he said, adding that "bad care is expensive care."

Tags: California Hospitals, Centers For Medicare And Medicaid, Centers For Medicare And Medicaid Services, David Carlisle, Dr David, Federal Insurance Program, Government Reimbursement, Health Care Costs, Health Planning, Hospital Admissions, Medi Cal, Medicaid, Medical Bills, Mountain Counties, Patient Care, Private Insurance, S Mountain, Sacramento Valley Region, State Researchers, Statewide Health