Illinois Blue Cross, hospitals target re-admissions

By Bruce Japsen
Posted Feb. 1 at 7:43 a.m.

Reducing costly re-admissions to hospitals is the goal of a new initiative being rolled out this year by Illinois’ largest health insurer and the state’s hospital lobby.

By 2014, Blue Cross and Blue Shield of Illinois and the Illinois Hospital Association say they hope to reduce re-admissions by 33 percent. In 2009 there were more than 50,000 re-admissions to the approximately 200 hospitals in the state.

Re-admissions are a costly part of the nation’s burgeoning tab for medical care and were often cited by President Barack Obama as he campaigning for health reform that ultimately passed Congress and was signed into law last year.

The private sector, too, rails against hospital re-admissions when they are forced to pick up the tab for a heart surgery not done right the first time or get a bill for a patient that gets an infection after being discharged for an unrelated knee or hip surgery. Just one additional day in the hospital because of a re-admission can cost several thousand dollars.

“With this project, we hope to achieve higher-quality care at a lower cost,” said Dr. Scott Sarran, vice president and chief medical officer at Illinois Blue Cross. “We believe investing resources to improve transitions of care will have major payoffs in costs and quality.”

There is no guarantee that all Illinois hospitals will participate in the program but Illinois Blue Cross is kicking in $1 million a year to help the facilities pay for educational programs for their doctors, hospitals and other health care workers.

There are, however, incentives built into the health law as well as market forces being instituted by health insurers that will push hospitals to improve quality by reducing re-admissions.

For example, hospitals that fall in the “bottom quartile” for certain heart- and pneumonia-related re-admissions for patients insured by the Medicare health insurance program for the elderly will have reimbursements reduced.

In addition, insurance companies like Illinois Blue Cross and UnitedHealth Group are already warning hospitals that health facilities that don’t abide by certain quality measurements in the future could be left out of health plan networks.

The hospital group and Illinois Blue Cross were short on specifics on exactly how they would reduce the re-admission rate that one study indicated is 20 percent for patients insured by Medicare. A 33 percent reduction in re-admissions of such patients would reduce that to 13 percent in Illinois and put the state in the average of hospitals across the country that are considered to have low re-admission rates.

This year, Blue Cross said it hoped to recruit 85 percent of the state’s hospitals into the program develop an improvement plan and “take action based upon the plan.”


Companies in this article


  1. jack (me) Feb. 1 at 9:17 a.m.

    Under all the talk about “re-admissions” and “quality” is that the writer won’t face that most of this is due to malpractice, and the medical community seems unwilling to do anything about it, especially if the malpractice results in a second hospital bill.

    The only thing cited that could have been independent was the infection in another body part, but then I remember the MRSA epidemic in hospitals.*

    *Of course, one also has to wonder about malpractice on the web, when the first hit on Google for MRSA is that “well known medical authority,” Wikipedia.

  2. Ella Feb. 1 at 9:18 a.m.

    It is truly hilarious that the government and insurance companies blame the hospitals for poor care when a re-admission occurs. As a nurse, I see patients who are discharged because the insurance company (including Medicare and Medicaid) will not pay for an extra day for a patient in heart failure (or with other diagnoses), even if their doctor says it’s necessary. The re-admission rates are a direct result of insurance companies, and Medicare insisting that patients be discharged before they are recovered enough. All of those decisions are made by people sitting behind desks looking at statistics, who have never even worked with a patient, telling us that a “typical” patient in heart failure stays 3 days. When the patient has a complication or has other comorbid illnesses, they are not allowed to stay even one day longer. They are forcibly discharged, and return the next day because they are even more ill. Somehow, that is the fault of the hospital, doctors and nurses. We can only do so much, with the time we are allotted.

  3. Ella Feb. 1 at 9:19 a.m.

    Jack, are you a health care professional, or a graduate of “Google University”? Where are your statistics regarding re-admission rates and malpractice? Please cite all of your REPUTABLE sources.

  4. gposner Feb. 1 at 9:44 a.m.

    DRGs (Diagnostic Related Groups) I believe are still used today to determine, on average, what a stay should be based on the condition.
    If there are complications, doctors, yes, to guard against fraud in the system, must justify the extra care/time needed, in writing, to be reimbursed. It happens. It does work. That said, unless you are shot, stabbed or are suffering a stroke or heart attack, stay out of the hospital where you can get sicker than when you first walked in..sepsis.
    Why would you want to join a bunch of sick people and be cared for by a lazy, apathetic staff who speaks broken english?

  5. Nick Feb. 1 at 9:46 a.m.

    Ella –

    No one can “force” a doctor or hospital to discharge a patient, certainly not an insurance company. You do so because the reimbursement runs out. If you were so confident in your “medical judgment” that the patient should remain an extra day, how about you keep the patient and write-off the cost? Doesn’t the Hippocratic oath require that?

  6. Nathan Feb. 1 at 12:05 pm

    Nick, just where is this free hospital that you’ve started? If insurance companies and medicare would up the reimbursement days readmissions would plummet. And no, the Hippocratic oath doesn’t require doing services for free and hospital administrators don’t take a hippocratic oath anyway.

  7. RC Feb. 1 at 12:46 pm

    Ella is right. Re-admissions are largely a continuation of an earlier stay. Doctors are always pressured by case managers to get the patient out ASAP especially if the patients stays past the allotted days and the hospital starts losing money. To reduce re-admissions means to keep a patient longer until he is really well enough to leave for home. Savings will be elusive as the only real mistake made by the hospital is releasing a patient too soon.

  8. AC Feb. 1 at 3:33 pm

    Is this the Universal Medicare thread?

  9. Alan Feb. 1 at 5:32 pm

    So if I, as a physician, discharge a CHF patient and they decide to go home and develop worsening heart failure because THEY either choose to not take their medication or follow their diet, it is my fault. GREAT!! In that instance, if the insurance company doesn’t pay for the readmission, and if the readmission is due to PATIENT NONCOMLIANCE, then the patient should be responsible for the entire bill.

  10. Alan Feb. 1 at 5:33 pm

    that’s NONCOMPLIANCE. sorry

  11. Brendan Feb. 1 at 7:58 pm

    I read in a newsweek article over a year ago that the 2 hospitals with the lowest re-admittance rates in the nation are also the two that are least profitable. I think it was Mayo and Salt Lake City. Highest quality care, as judged from the patient view, makes them the least profitable. All the wrong incentives are in place in this health care system and it will take a long time to unwind those and correct. Start with legal reform, slowly reduce the systemic incentive to specialize in medicine, grow the incentive for general practitioners that actually do preventative medicine, turn it on its ear.

  12. George Feb. 1 at 8:08 pm

    The only thing insurance does is pay, or not, for treatment. They do not decide who gets treatment, and not all policies cover everything. If a patient is discharged too early it’s because of a decision by the doctor and/or the patient.

  13. Matt Feb. 1 at 11:34 pm

    Quoting George:
    If a patient is discharged too early it’s because of a decision by the doctor and/or the patient.

    @George – I disagree. My mother was discharged from the hospital because the insurance companies wouldn’t pay for any more physical therapy after a series of medical illnesses happened.

    1 week later, my mother ends back up into the hospital, readmitted. She’s still in there.

  14. elongated Feb. 3 at 2:42 pm

    Then why are hospitals, nurses, and doctors so reluctant to participate in best practices? If a peer group has devised a method of best practices and they are not followed by others in the industry, do we automatically blame the government and insurance companies for rising health care costs and re-admittance? Perhaps if nurses washed their hands and instruments were sterilized as per best practices we wouldn’t have to re-admit the same patients over and over again.(BTW insurance companies operate at a 2% profit, there’s not a whole lot of wiggle room there. I’m assuming your hospital is “non-profit”? Didn’t think so.)

  15. Anne Feb. 3 at 7:52 pm

    Hospitals could easily implement programs to decrease the rate of hospital readmissions for CHF patients by maximizing / optimizing drug therapy. Several studies have proven this by individualizing and maximizing ACE inhibitor therapy for CHF patients….(sorry don’t have the journal article to cite at the moment).

    Unfortunately, these programs are not implemented in the hospital because……the more admissions a hospital has…..the more money it makes. Again, the almighty dollar rules…..just so hospital administrators can make mega-bucks and hefty bonuses to boot.