Readmit rate improves ever so slowly

HOW YOU INTERPRET the avoidable hospitalization data in the Agency for Healthcare Research and Quality's (AHRQ) annual quality report depends entirely on your perspective.

"It's a good news/bad news kind of thing," says Ernest Moy, MD, medical officer with AHRQ's Center for Quality Improvement and Patient Safety. "There's a lot of evidence that we are moving in the right direction, we're just doing it slowly."

Unfortunately, the cost trend of such hospitalizations hasn't fallen at the same rate. Inpatient costs increased during the first three years of the study period, reaching a peak. They were ultimately higher in 2008 than they had been at the beginning of the study period, despite the later decline. From the peak in 2003 to the 2008 endpoint, potentially avoidable hospitalization costs fell 5.7%.

Several factors have helped reduce the rate of avoidable hospitalizations, Dr. Moy says. Hospitals have become more skilled at addressing complaints such as dehydration and asthma in the emergency department, enabling certain patients to avoid admission. Patients deserve credit as well, as many are taking a more active role in managing their chronic conditions. Unfortunately, he says, adequate access to primary care-a critical element-remains precariously out of balance, attributed to the shortage of primary care physicians in many areas.

Demographic data regarding avoidable hospitalizations underscores the role of primary care. Populations that face the most barriers to primary care have the highest rates of avoidable hospitalizations: rates were higher for low-income individuals and blacks than for higher-income individuals and whites.

To put the data in perspective, the report compared national performance to that of the best performing states. At the current rate, it would take the nation 20 years to reach the avoidable hospitalization rate achieved by top-performing Hawaii, Utah and Washington, states whose average rate of 818 per 100,000 population is roughly 43% lower than that of the nation as a whole.

Still, there is cause for hope, Dr. Moy says. By making insurance more broadly available, healthcare reforms will remove a major obstacle to care. What's more, promoting more coordinated, accountable care organizations should enable caregivers to address potentially dangerous complaints before they require hospitalization. CMS and private payers are putting pressure on healthcare providers to improve quality and lower costs.

"I think everybody knows that in terms of reducing overall costs, reducing hospitalization costs is where you can get the biggest bang for your buck," Dr. Moy says.

Despite those forces, change can be painfully slow.

"We want things to get better faster," Dr. Moy says. "It doesn't help people who are paying high insurance premiums now to know that in 20 years things will get better."

-Shelly Reese