AHRQ Finds Hospital Readmission Rates High Among Medicaid “Super-Utilizers”

Medicaid “super-utilizers” accounted for half of all 30-day hospital readmissions for the Medicaid population in 2012, with a readmission rate nearly six times as high as that for other Medicaid patients, a new statistical brief from AHRQ concludes. Super-utilizers, or patients who had four or more hospital admissions annually, are a relatively small group of patients who account for a disproportionately large share of hospital services and costs. The authors examined data from AHRQ’s Healthcare Cost and Utilization Project and found that the 30-day all-cause readmission rate among super-utilizers was 52.4 percent compared with 8.8 percent for other Medicaid patients. Medicaid super-utilizers’ hospital stays also were longer and more expensive. The two most common reasons for hospitalization among these patients were mood disorders, and schizophrenia and other psychotic disorders. Medicaid is the largest public health insurance program in the United States, with more than 67 million beneficiaries. The statistical brief is titled, “Characteristics of Hospital Stays for Nonelderly Medicaid Super-Utilizers, 2012.”

Characteristics of Hospital Stays for Nonelderly Medicaid Super-Utilizers, 2012

H. Joanna Jiang, Ph.D., Marguerite L. Barrett, M.S., and Minya Sheng, M.S.

Introduction

With over 67 million beneficiaries, Medicaid has emerged as the largest health insurance program in the United States. ¹ The Medicaid population includes infants, children, young mothers, homeless adults, individuals with disabilities, and individuals who are dually eligible for Medicare and Medicaid. The considerable diversity among patients covered by Medicaid in age, race/ethnicity, and type of health conditions poses great challenges for managing the use of health services by this population. Specifically, among patients with physical or behavioral chronic conditions, Medicaid patients have been shown to experience higher hospital readmission rates than privately insured patients,² suggesting that a relatively small group of patients may account for a disproportionately large share of utilization and costs. Understanding the characteristics and patterns of hospitalization for high-utilizing patients can help policymakers and clinicians develop interventions to address the special needs of these patients and reduce their risks for multiple hospitalizations.

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief presents data on patient demographics and characteristics of hospital stays for Medicaid super-utilizers compared with stays for other Medicaid patients. For this report, super-utilizers are defined as patients who had four or more hospital admissions³ during 2012. The most common principal diagnoses for hospital stays are also identified for these super-utilizers.

Weighted national estimates are produced from 18 HCUP State Inpatient Databases (SID) that capture hospital discharge data from both fee-for-service and managed care Medicaid enrollees and allow for examination of readmissions because they include a valid encrypted patient identifier that allows for tracking across hospital stays. This analysis includes only patients aged 1 to 64 years covered by Medicaid who did not have Medicare listed as a payer. Differences greater than 20 percent between weighted estimates are noted in the text.

Findings

Patient demographics of Medicaid super-utilizers, 2012
Table 1 presents demographic characteristics of Medicaid super-utilizers compared with other Medicaid patients who were hospitalized in 2012.

Highlights

In 2012, on average compared with other Medicaid patients, Medicaid super-utilizers had more hospital stays (5.9 vs.1.3 stays), longer length of stay (6.1 vs. 4.5 days), and higher hospital costs per stay ($11,766 vs. $9,032).

Medicaid super-utilizers accounted for 14 percent of Medicaid hospital stays and 18 percent of Medicaid hospital costs.

Medicaid super-utilizers were more likely than other Medicaid patients to be male and to be aged 45-64 years.

The 30-day all-cause readmission rate for super-utilizers was nearly six times higher than for other Medicaid patients (52.4 vs. 8.8 percent). Half of all 30-day readmissions for the Medicaid population were attributable to super-utilizers.

Mood disorders and schizophrenia and other psychotic disorders were the two most common reasons for hospitalization among Medicaid super-utilizers. Alcohol-related disorders ranked number six.

Other common conditions among super-utilizers included diabetes; cancer treatment, sickle cell anemia; septicemia; congestive heart failure; chronic obstructive pulmonary disease; and complications of devices, implants and grafts.