Note: Data for individual hospitals is not available; hospital locations are shown for informational purposes.
Two out of every 10 New Jersey Medicare patients wind up back in the hospital within a month of being discharged, a rate that has been slowly dropping over the past four years, according to data released this week.
But while the rates have been dropping, major reductions could prove difficult to achieve, since there appears to be some correlation between rates and demographic factors.
On Wednesday, Healthcare Quality Strategies Inc., a New Jersey-based organization that compiles and releases healthcare data,showing that roughly 20 percent of Medicare patients were readmitted to a hospital within 30 days of being released in the fourth quarter of 2012. That was 0.8 percent lower than a year earlier and 1.5 points less than in the final quarter of 2008. It released the statewide data, as well as information for each county, at a conference it cosponsored called Improving Transitions of Care: Improving Quality and Reducing Unnecessary Readmissions.
New Jersey historically has struggled compared with other states in readmissions, despite being among the highest states in spending per patient.
The information is important because the federal Affordable Care Act penalizes hospitals for excess readmissions. Medicare currently penalizes hospitals with high readmission rates, based on readmission data from the three prior years. The penalties in 2011 were up to 1 percent of a hospital's entire Medicare reimbursement and will increase to 3 percent by 2014.
In 2012 nearly every hospital in New Jersey lost some funding. Going forward, however, hospitals in the state should see fewer penalties as patients experience fewer readmissions within 30 days of discharge.
HQSI project coordinator Daina Bungs said the ACA has helped spur hospitals to strengthen their relationships with local healthcare providers, with a goal of making sure that patients continue to take steps to avoid returning to the hospital.
“Certainly that is one of the driving forces that hospitals are responding to,” Bungs said of the federal law.
But wide-scale reductions may be difficult, since the county data, which includes readmissions by race, length of stay, and diagnosis, shows some correlations with race and income.
For instance, Hunterdon County, which has the highest median-household income and second-largest percentage of the population that is non-Hispanic white, has the lowest readmission rate -- just shy of 17 percent in the last quarter of last year. Sussex, which had the second-lowest rate has the state’s least diverse population and the fourth-highest median income.
Similarly, Hudson County had the highest readmission rate of 24 percent and has the state’s most diverse population – nearly 7 in 10 are non-Hispanic white and its median income is among the bottom third of counties in the state.
But that is not always the case. HQSI is working to help hospitals and community organizations collaborate better to support patients at home and has found its efforts are working.
“The data shows that the interventions at hospitals and the post-acute care providers such as nursing facilities and home health agencies are starting to have an impact on care transitions,” said Bungs. “We are working to help facilitate those collaborations.”
“There are times when patients need to be in the hospital, but many readmissions are avoidable,” said Dr. Andrew Miller, medical director of HQSI. “Patients and their families are much better off if the patient can stay at home and out of the hospital. We are not talking about cutting care, we are talking about improving care to reduce unnecessary readmissions.”
At the conference, several nurses who work on care transitions said patients frequently return home unsure of what medications they should be taking, regardless of whether medications were discussed when they were discharged from the hospital.
“The home visit is the key to reducing readmission rates,” said Tammy Scovern, a nurse and discharge coach for Inspira Health Network in Vineland. “At the hospital, patients are focusing on going home and don't always listen to the discharge plan. When they are home they know they have to be accountable for their own care and they are focused and really listening. When you are in the home you can see what is really going on -- what they are eating, what medications they are actually taking,” Scovern said.
The readmission improvement is a positive sign, but hospital officials “know we still have a ways to go,” according to Aline Holmes, senior vice president of clinical affairs for the New Jersey Hospital Association. “We’re still a state with one of the highest readmission rates in the country.”