One in three adult patients—aged 21 and older—discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new national study by the Center for Studying Health System Change (HSC) for the nonpartisan, nonprofit National Institute for Health Care Reform (NIHCR).
Even 90 days after discharge, 17.6 percent still had not seen a physician, nurse practitioner or physician assistant, the study found. Many adults who do not see a physician after discharge are at high risk of readmission because of chronic conditions or physical activity limitations, according to the study, which used 2000-08 data from the nationally representative Medical Expenditure Panel Survey (MEPS) to estimate the prevalence of hospital readmissions for all causes—other than obstetrical care—for adults aged 21 and older.
About one in 12 adults (8.2%) aged 21 and older discharged from a hospital to the community was readmitted within 30 days, according to the study, and one in three adults (32.9%) was rehospitalized within one year of discharge.
Reducing avoidable hospital readmissions is viewed as a way to improve quality and reduce unnecessary costs. While policy makers have targeted readmissions stemming from poor quality of care during an initial hospital stay, readmissions also can occur when patients don’t receive appropriate follow-up care or ongoing outpatient management of other conditions.
The study findings indicate that gaps in care after discharge are common for adults covered by all types of insurance. The lack of a usual source of care does not appear to be a barrier to receiving follow-up care, but many patients discharged from a hospital to home face challenges accessing their usual source of care.
“The implication is that reforms specific to one payer and focusing only on care processes within hospitals may fall short unless efforts to coordinate with community providers—and to encourage patients’ access to these providers—receive at least as much attention,” said HSC Senior Researcher Anna Sommers, Ph.D., coauthor of the study with Peter J. Cunningham, Ph.D., HSC director of quantitative research.
Strategies that could address gaps in care after discharge include bundled payments and patient-centered medical home efforts, which have potential to encourage hospitals and community-based clinicians to work together to lower rates of avoidable readmissions or rehospitalizations for other conditions. Moreover, investments in well-designed health information technology could help physician practices identify and monitor care for high-risk patients and foster information sharing between hospitals and community-based physicians.
The study’s findings are detailed in a new NIHCR Research Brief—Physician Visits After Hospital Discharge: Implications for Reducing Readmissions—available here.
Other key findings include:
- Thirty-day readmission rates are much higher for people who are sicker, ranging from 5 percent for adults in excellent or very good health to about double that for people in fair to poor health. People reporting a limitation of their daily activities, such as bathing or dressing, and people with two or more chronic conditions also had higher readmission rates compared to people without these problems.
- Among adults aged 21 to 64, readmission rates were highest for people with public coverage, mainly Medicare or Medicaid. These higher rates, in part, reflect the relatively poor health of people under age 65 who qualify for Medicare or Medicaid based on disability.
- The vast majority of people admitted to a hospital reported having a usual source of care (90%). However, having a usual source of care does not guarantee easy access to a provider. Only about a third of people with a usual source of care reported that after-hours care—nights and weekends—was available, and about one-fifth said it was difficult to contact their usual source of care by phone about a health problem. One in 10 reported difficulty getting to their usual source of care, which may reflect long travel times or lack of transportation.
- On an annual basis, expenditures were $16.3 billion for hospital readmissions up to 30 days after discharge. While much of the policy focus has been on changing payment incentives in Medicare to decrease readmissions, private insurance pays for a greater share of 30-day readmissions (about 47%) than does Medicare (about 40%).