New data show difficulties in controlling patient ‘rebound’ at care facilities

The Veterans Health Administration, the largest integrated health care system in the country, has long employed many of the approaches Medicare is pushing on all hospitals to reduce unnecessary readmissions. But new data show VA hospital patients are just as likely to end up back in a hospital bed as are patients at private hospitals.

The new statistics underscore how hard it may be for hospitals to stop patients from rebounding back through their doors, a major goal of Medicare as it seeks to curtail the nation’s ballooning health costs.

VA hospital patients aged 65 or older suffering from heart failure, heart attacks or pneumonia returned to a hospital within a month at the same rate as did Medicare patients initially cared for at private hospitals, according to an analysis of the data. The data were published by Medicare last month on its Hospital Compare Web site.

Out of 107 VA hospitals evaluated on the site, only one, based in Portland, Ore., had significantly lower readmissions rates than did the average U.S. hospital, and that was only for one condition, heart failure. Fifteen VA hospitals had higher-than-average readmission rates for one or more of the three ailments tracked by Medicare.

“It makes you wonder how much hospitals can really control readmissions if a place like the VA cannot have dramatically lower rates,” said Dr. Ashish Jha, a Harvard School of Public Health professor who also practices medicine at the VA Boston Healthcare System and advises the department’s leadership.

“This is an organization that has been very focused on effective discharge planning,” Jha said. “This is what the federal policymakers are trying to push the country towards. They’re trying to create the kind of accountability the VA already has. On most other issues, the VA does very well, and yet on this one metric, not so much.”

Dr. Peter Almenoff, a senior VA official, said the results “validate the fact that our care is as good as or better than in the private sector.” He said that while the VA tracks readmissions to its own hospitals, it wasn’t aware of the total picture, including readmissions to private hospitals, until Medicare published the data. “We’re trying to understand why they come back, or go to local hospitals,” said Almenoff, assistant deputy undersecretary for quality and safety at the VA.

By one estimate, readmissions cost Medicare $26 billion a year, with one in five patients landing back in the hospital within a month. Many experts say that while some of the returns are necessary, others could be avoided if hospitals made more of an effort to prepare and oversee patients after they leave.

But the current payment method used by Medicare and many private insurers can work against that, since hospitals are often eager to fill up their beds to earn more. “Currently, it’s not always in the best interest of hospitals to do this work because they get paid for every admission,” said Patricia Rutherford, a vice president at the nonprofit Institute of Healthcare Improvement in Cambridge, Mass.