A new study published in the Annals of Emergency Medicine found that Medicare’s Hospital Readmissions Reduction Program may be missing a large number of patients who return to the hospital within 30 days of discharge. The Hospital Readmissions Reduction Program penalizes hospitals that have a high rate of patients readmitted to the hospital within 30 days of discharge. However, the program does not count recently-discharged patients who were treated and discharged from the emergency department within 30 days. “Many patients return to the hospital, via the emergency department, within 30 days of discharge from the hospital but are not being counted in measurements of readmissions,” said lead study author Kristin Rising, MD, of the Perelman School of Medicine at the University of Pennsylvania. “Unless they are readmitted to the hospital through the ER, these patients are invisible. The Centers for Medicare and Medicaid has invested heavily in preventing hospital readmissions within 30 days, but by limiting the focus only to inpatient-to-inpatient events and omitting ER visits, they are missing a substantial source of healthcare utilization that is managed solely in the emergency department.” The study looked at 11,976 patients discharged from Boston Medical Center from January 1 to June 30, 2010. The total number of impatient discharges during the period studied was 15,519, including patients who were readmitted more than once. Nearly one quarter (23.8%) of the discharges resulted in at least one ED visit within the subsequent 30 days. More than half of the ED visits did not warrant inpatient admission. Non-hypertensive congestive heart failure was the diagnosis with the highest rate of return ED visits (31.8%) and the highest rate of 30-day readmissions (82.6%). A similar study published in JAMA found that ED visits within 30 days were common among adults and accounted for 39.8% of post-discharge hospital-based acute care visits. Authors of that study also said improving care transitions should focus on ED visits. It seems that if the goal of the Hospital Readmissions Reduction Program is to encourage effective care transitions and prevent patients from returning to the hospital soon after discharge, it would make sense to include follow-up ED visits. What do you think?