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Fewer return quickly to hospital

– Over the past several months, America’s hospitals have achieved a feat that long seemed beyond reach: substantially reducing the share of patients who must return for treatment almost as soon as they are discharged.

According to statistics compiled by the Obama administration, the nationwide rate of hospital re-admissions of Medicare patients within 30 days of discharge declined to about 17.8 percent by last November after remaining stuck near 19 percent over the five years that the data has been collected, and likely for decades prior to that.

Jonathan Blum, an official at the Centers for Medicare and Medicaid Services, thinks the drop – which amounts to tens of thousands of people kept out of the hospital – is largely the result of provisions in President Obama’s health-care law.

These include new financial penalties that Medicare, the federal health program for the elderly and disabled, has begun imposing on hospitals with high re-admission rates. They also include extra funding and incentives for hospitals and outpatient providers to do a better job of coordinating care for patients after they head home.

“What I think is exciting is that a couple years ago, the general reaction to these policies was that it was impossible to reduce hospital re-admissions,” Blum said.

Even though Medicare’s spending per beneficiary rose by only 0.4 percent in 2012 – compared with an average of 1.9 percent in the preceding three years – many analysts say the program continues to threaten the country’s long-term fiscal health, primarily because of the aging of the baby boomers.

Administration officials hope that reducing unnecessary hospital re-admissions will be a powerful, and politically palatable, tool for further curbing Medicare spending.

The data do not pinpoint the reasons for the reduction in the Medicare re-admissions rate. But officials stressed that the decline occurred in part because of a combination of carrots and sticks in the health-care law, the Affordable Care Act.

The law, for example, includes a stream of funding for organizations promoting better coordination of patient care, such as 26 “hospital engagement networks” across the country that are working with 3,700 hospitals to identify ways to reduce unnecessary re-admissions.

One of the largest such groups, Premier Healthcare Alliance, which has a $24 million two-year contract to serve 450 hospitals, has used the money to hire an army of advisers to come up with specific strategies tailored to each location.

Perhaps more significantly, Medicare in October began penalizing 2,217 hospitals under the law for having too many re-admissions.

More than 300 hospitals were hit with the maximum fine: a 1 percent reduction in their Medicare payments for every patient over the coming year.