If rehospitalization is considered when grading health care, America's system is not all it is cracked up to be. Proof? New evidence indicates almost a quarter of heart failure patients with Medicare are back in the hospital within a month after discharge, researchers report today in Circulation: Heart Failure.

Each year, from 2004 through 2006, more than a half million Medicare recipients over age 65 went to the hospital for heart failure and were discharged alive.  And each year, about 23 percent returned to the hospital within 30 days – signaling a need to improve care, researchers said.  Readmission rates for all causes were almost identical all three years.

According to the study, the biggest issue is that the current fee system in the United States doesn't encourage a focus on prevention, the researchers said.  In their analysis they report that doctors and hospitals are financially awarded more for treating and hospitalizing patients, not for preventing hospitalizations through such strategies as disease management.

"Physicians aren't paid to coordinate care," lead author Dr. Joseph Ross said.  "That physician is busy seeing patients and that's what they're paid to do.  If we want to deliver better care, this trend is what we need to address."

Another barrier to optimal care is a lack of communications between doctors who care for patients in the hospital and the patients' regular physicians who help patients manage their chronic disease, Ross said.  The disruption to the continuum of care can negatively affect the patient.

The average age of patients in the study was 80 years and more than half (57 percent) were women.  Most patients had multiple chronic diseases: 60 percent had heart arrhythmias; 73 percent had atherosclerosis or hardening of the arteries; 49 percent had diabetes; and 29 percent had kidney failure.

"Coming back and forth into the hospital isn't good for patients, and it isn't good for the healthcare system," said Ross, who plans to research the reasons heart failure patients are readmitted to the hospital.  "This is a tremendous challenge."

"Patients should use this information to vet hospitals, to look at the quality of care delivered there and ask questions about the care they receive," Ross said.  "Hospitals should consider the rehospitalization rate a grade which, from these findings, needs improvement."

Citation: Joseph S. Ross,Jersey Chen Zhen Qiu Lin, Héctor Bueno, Jeptha P. Curtis, Patricia S. Keenan, Sharon-Lise T. Normand, Geoffrey Schreiner3, John A. Spertus, Maria T. Vidán, Yongfei Wang, Yun Wang, Harlan M. Krumholz, 'Recent National Trends in Readmission Rates after Heart Failure Hospitalization', Circulation: Heart Failure, 2009, doi: 10.1161/CIRCHEARTFAILURE.109.885210