NCPA - National Center for Policy Analysis

Return Emergency Room Visits after Discharge Not Counted in Readmission Rates

April 15, 2013

Hospital readmission rates are an important indication of the quality and the effectiveness of care that patients receive. After a patient receives care, there is a transition period after initial discharge in which the patient may return to the emergency department (ED) for additional care.  ED visits are often not counted as part of readmission rates and hospitals need to focus on tracking and reducing their prevalence, says Kaiser Health News.

  • Within 30 days of initial discharge, hospital readmissions are frequent and costly, and the Centers for Medicare and Medicaid services has made substantial investments in lowering rehospitalizations.
  • Currently, readmissions are only defined as an inpatient discharge to inpatient readmission and do not track ED visits or observation stays.

A new study in the Annals of Emergency Medicine tracks 11,976 patients who were discharged from Boston Medical Center in the first half of 2010.

  • The study finds that 21 percent of the discharges resulted in at least one ED visit within a month after the patients left the hospital.
  • More than 50 percent of those visits to the ED did not lead to readmissions and were thus not counted in readmission statistics.
  • Patients who returned to the ED but were not readmitted returned to the hospital an average of three days earlier than those who were readmitted.
  • The patients who returned to the ED within 30 days tended to be older, male and English-speaking.

Hospitals need to focus on limiting readmissions and measuring ED visits in their readmission statistics. Accounting for these visits would give hospitals a more comprehensive view of the quality and effectiveness of the treatments being offered.

  • The study replicates results of another study published in the Journal of the American Medical Association that found that for every 1,000 discharges, 98 patients would soon return to the ED.
  • Medicare is penalizing hospitals that have high rates of readmissions for elderly patients suffering from heart attacks, heart failure or pneumonia.
  • More than 2,000 hospitals will see their reimbursements reduced up to 1 percent of their regular payments for high readmission rates.

Source: Jordan Rau, "Medicare Effort to Cut Readmissions Isn't Counting Patients Who Come Back to ER," Kaiser Health News, April 9, 2013. Kristin L. Rising et al., "Emergency Department Visits After Hospital Discharge: A Missing Part of the Equation," Annals of Emergency Medicine, April 8, 2013.


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