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A variety of different measures all point to one inescapable fact: readmissions of Medicare patients at Massachusetts hospitals are steadily decreasing, according to a new MHA analysis.

Statistics over the past decade show that Massachusetts hospitals, as well as hospitals nationwide, over the past decade at first had incremental improvements in readmissions before experiencing a significant drop beginning in 2012.  The improvements may be due to the increased focus on the issue that hospitals undertook in response to Medicare readmission penalties that the federal government instituted in recent years.

The data shows that readmissions held steady for about seven years and then beginning in 2012, and continuing in 2013, readmissions declined distinctly. (The 2012-to-2013 decrease was slower than the 2011-to-2012 decrease, however.)

Another measure, which focuses on "all-cause" readmissions and not just those confined to heart attack, heart failure, and pneumonia patients, shows Massachusetts readmissions dropping 1.9% in 2013 versus 2012.

Yet another source of data - "Medicare 30-day unadjusted all cause readmission measures for fee-for-service beneficiaries of all ages" - was developed by CMS to help target geographic variation in care. MHA's analysis of this data showed Massachusetts readmission rates went from 8.1% above U.S. rates in 2008 to 2.3% above in 2013. Readmissions per 1,000 beneficiaries dropped for five consecutive years in both Massachusetts and the U.S., and at a continuously acclerating pace. Readmissions and readmissons per 1,000 beneficiaries dropped more than 20% from FFY 2007 to FFY 2013 in both Massachusetts and the U.S.

David Smith, MHA's Senior Director, Health Data Analysis & Research, says, "The decline in Medicare readmissions may have been caused by care improvements - such as better case management, improved care transitions, and coordinated care practices - that were incentivized by payment reforms such as the Medicare Readmission Reduction Program."

In 2013, MHA's Board of Trustees challenged all hospitals to reduce readmission rates by 20% over the next three years, and MHA has been leading the effort to bring providers together to share strategies of what works to reduce re-hospitalizations.

But lowering readmissions is not always easy. Patients move from one setting of care to another or to one set of care providers to another during an episode of illness. As patients and families navigate across new care settings and among different care providers, they often encounter communication challenges and confusion around who is clearly accountable for their care. This can lead to medical errors, duplication, increased costs and, sometimes, higher rates of re-hospitalization.

Scholarship has also demonstrated that hospitals serving socioeconomically disadvantaged populations incur more readmission penalties than other hospitals. Because poorer people may find it hard to fill prescriptions, adhere to complex post-hospital care regimens, and travel to outpatient clinics, their chances for readmissions increase. Reducing funding to hospitals that serve the poor creates a situation, according to recent studies, whereby access to care for the poor is reduced.