Dartmouth Readmissions Report Shows Scant Progress

Goodman asserts that it is fair to criticize hospitals for not reducing readmission rates by 2010, the year that the Patient Protection and Affordable Care Act was signed and the first time many hospitals realized that readmissions would be penalized up to 3% of their Medicare DRG payment.

"The interest and concern about higher readmission rates really extends back at least 15 years, both in terms of recognizing that they are too high, as well as the development of care models that are effective at reducing them," Goodman says. "This is quite a long-standing problem that's not news to anyone in the healthcare community."

Goodman adds that a frequently overlooked aspect of this report and others published by Dartmouth is that hospitals with higher readmission rates tend to have higher admission rates in the first place.

"Part of this is explained by the way healthcare systems have invested and the way they've built themselves over the years, like how many intensive care unit beds and hospital beds they have, and how many hospital beds they have, rather than whether the community has built up good community care capacity," he says.

These aspects of healthcare are "distinctive patterns that are often invisible to the hospital and doctors themselves, and certainly to the patient, but they're very powerful."

"It's not just a matter of whether the nurse calls the patient up after they leave the hospital in the first 30 days to make sure they're taking their medication," Goodman continues. "There really needs to be some broader changes, in terms of whether systems are building hospital care or building community care."

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