Must be a calmer week at OMB as Peter Orszag has been throwing up some general policy posts. Of particular interest to health wonks will be this rumination on hospital readmissions. The peg here is a New England Journal of Medicine study that found "that approximately 20 percent of Medicare beneficiaries discharged from a hospital were rehospitalized within 30 days. The authors estimate rehospitalizations accounted for about $17.4 billion of the $102.6 billion in hospital payments from Medicare in 2004." Health policy experts tend to think that many of those rehospitalizations are unnecessary, and substantial money could be saved by preventing them. In particular, Orszag notes that "the study found that rehospitalization rates vary substantially by geographic area; the rehospitalization rate was 45 percent higher in the five states with the highest rates than in the five states with the lowest rates. (These rates are calculated in a way that controls for the severity of illness across hospitals, so the difference in rates can’t be explained by the fact that some hospitals have sicker patients than others.)"This gets to a point Orszag has made before: A lot of attention accrues to international health spending comparisons. France spends X and we spend Y. But given differences in culture, system structure, doctor payment, population health, and much else, there are a lot of confounding variables in such comparisons. There are also, however, massive differences between different states in America. South Dakota and Florida aren't the same, of course. But they're not that different. And if we could get Florida to spend more like South Dakota, that alone would be a huge improvement. CBO, as you might imagine, has produced a very good report on this subject. COMPARED TO SPAIN, OR MAYBE SOUTH DAKOTA.
Must be a calmer week at OMB as Peter Orszag has been throwing up some general policy posts. Of particular interest to health wonks will be this rumination on hospital readmissions. The peg here is a New England Journal of Medicine study that found "that approximately 20 percent of Medicare beneficiaries discharged from a hospital were rehospitalized within 30 days. The authors estimate rehospitalizations accounted for about $17.4 billion of the $102.6 billion in hospital payments from Medicare in 2004." Health policy experts tend to think that many of those rehospitalizations are unnecessary, and substantial money could be saved by preventing them. In particular, Orszag notes that "the study found that rehospitalization rates vary substantially by geographic area; the rehospitalization rate was 45 percent higher in the five states with the highest rates than in the five states with the lowest rates. (These rates are calculated in a way that controls for the severity of illness across hospitals, so the difference in rates can’t be explained by the fact that some hospitals have sicker patients than others.)"This gets to a point Orszag has made before: A lot of attention accrues to international health spending comparisons. France spends X and we spend Y. But given differences in culture, system structure, doctor payment, population health, and much else, there are a lot of confounding variables in such comparisons. There are also, however, massive differences between different states in America. South Dakota and Florida aren't the same, of course. But they're not that different. And if we could get Florida to spend more like South Dakota, that alone would be a huge improvement. CBO, as you might imagine, has produced a very good report on this subject. 
