Rehospitalizations Among Patients in the Medicare Fee-For-Service Program

N Engl J Med. 2009 Apr 2;360(14):1418-28. doi: 10.1056/NEJMsa0803563.

Abstract

Background: Reducing rates of rehospitalization has attracted attention from policymakers as a way to improve quality of care and reduce costs. However, we have limited information on the frequency and patterns of rehospitalization in the United States to aid in planning the necessary changes.

Methods: We analyzed Medicare claims data from 2003-2004 to describe the patterns of rehospitalization and the relation of rehospitalization to demographic characteristics of the patients and to characteristics of the hospitals.

Results: Almost one fifth (19.6%) of the 11,855,702 Medicare beneficiaries who had been discharged from a hospital were rehospitalized within 30 days, and 34.0% were rehospitalized within 90 days; 67.1% [corrected] of patients who had been discharged with medical conditions and 51.5% of those who had been discharged after surgical procedures were rehospitalized or died within the first year after discharge. In the case of 50.2% [corrected] of the patients who were rehospitalized within 30 days after a medical discharge to the community, there was no bill for a visit to a physician's office between the time of discharge and rehospitalization. Among patients who were rehospitalized within 30 days after a surgical discharge, 70.5% were rehospitalized for a medical condition. We estimate that about 10% of rehospitalizations were likely to have been planned. The average stay of rehospitalized patients was 0.6 day longer than that of patients in the same diagnosis-related group whose most recent hospitalization had been at least 6 months previously. We estimate that the cost to Medicare of unplanned rehospitalizations in 2004 was $17.4 billion.

Conclusions: Rehospitalizations among Medicare beneficiaries are prevalent and costly.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Diagnosis-Related Groups
  • Fee-for-Service Plans / economics
  • Fee-for-Service Plans / statistics & numerical data*
  • Humans
  • Length of Stay
  • Medicare / economics
  • Medicare / statistics & numerical data*
  • Mortality
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data*
  • United States / epidemiology