Trends in Hospital Readmissions for Four High-Volume Conditions, 2009–2013
Kathryn Fingar, Ph.D., M.P.H., and Raynard Washington, Ph.D
Note: The following study was not conducted by any Care4Me or Helios Health Group employee and all credit goes to The Healthcare Cost and Utilization Project (H-CUP) an Agency for Healthcare research and Quality project.
Hospital readmissions can have negative consequences for patients and the hospitals at which they are treated, and also are costly for both public and private payers. In 2011, Medicare paid for 58 percent of all readmissions, followed by private insurance (20 percent) and Medicaid (18 percent). Readmissions are a significant portion of Medicare spending—37 percent of total Medicare spending is for inpatient care, and 18 percent of all inpatient admissions paid by Medicare are readmitted within 30 days, accounting for $15 billion in costs annually. In addition to these costs, repeat hospitalizations place patients at greater risk for complications, hospital acquired infections, and stress. Because the majority of readmissions are for nonsurgical services, it is unlikely that readmissions are profitable for hospitals.
Although it may be necessary to readmit some patients, the fact that risk-adjusted readmission rates vary considerably across hospitals suggests that certain readmissions may be prevented through hospital practices, such as improving patient discharge instructions, coordinating postacute care, and reducing medical complications during the initial hospital stay.
The Affordable Care Act established the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program (HRRP) to provide a financial incentive for hospitals to reduce preventable readmissions. Effective in 2013, the HRRP imposes a financial penalty for hospitals with excess rates of readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia among Medicare beneficiaries.