As score-keeping begins for new Medicare penalties for hospitals with excessive numbers of patients returning shortly after they're discharged, a new Dartmouth Atlas Project report shows little progress over a five-year period in reducing these hospital readmissions and improving care coordination for Medicare patients. In fact, the statistics show that readmissions for some conditions are on the rise.

“Readmission rates for some conditions have increased nationally and for many regions and hospitals, including some of America's most elite academic medical centers,” the report notes.

For 20 years, the Dartmouth Atlas Project has documented glaring variations in how medical resources are distributed and used in the United States. The project uses Medicare data to provide information and analysis about national, regional, and local markets, as well as hospitals and their affiliated physicians.

The most recent report shows that roughly one in six Medicare patients wind up back in the hospital within a month after being discharged for a medical condition.

[See also: CMS to pay $2.3M for help reducing hospital readmissions.]

In an examination of the records of 10.7 million hospital discharges for Medicare patients, researchers found striking variation in 30-day readmission rates across regions and academic medical centers. Researchers also found that more than half of Medicare patients discharged do not see a primary care clinician within two weeks of leaving the hospital, and that facilities and regions with general patterns of high use of hospitals for medical conditions were frequently the same places with high readmission rates, an indication that some communities are more likely than others to rely on the hospital as a site of care across the board.

"The report highlights widespread and systematic failures in coordinating care for patients after they leave the hospital," said David C. Goodman, MD, lead author and co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice. "Irrespective of the cause, unnecessary hospital readmissions lead to more tests and treatments, more time away from home and family, and higher healthcare costs."

The readmission rate to a hospital is increasingly seen as a marker of a local healthcare system's ability to coordinate care for patients across care settings, and readmissions are often a sign of inadequate discharge planning and the lack of effective community-based care, according to Goodman.

The Centers for Medicare & Medicaid Services (CMS) has estimated the cost of avoidable readmissions at more than $17 billion a year. In hopes of decreasing these costs, Medicare plans to reduce payments for readmissions, exposing hospitals to considerable financial risks. In fiscal year 2013, hospitals face a penalty equal to 1 percent of their total Medicare billings if an excessive number of patients are readmitted. The penalty rises to 2 percent in 2014 and 3 percent in 2015.

[See also: HHS launches Partners for Patients.]

"The need to develop more efficient systems of care that include discharge planning and care coordination is clear," said Elliott S. Fisher, MD, report author and co-principal investigator of the Dartmouth Atlas Project and director of the Center for Population Health at the Dartmouth Institute for Health Care Policy and Clinical Practice. "The report shows the opportunity for improvement, and the importance of aligning efforts to reduce readmissions with other policy and payment initiatives."

More report findings on next page.