Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013 #196

Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013 #196

Highlights

In 2013, there were about 500,000 readmissions totaling $7 billion in aggregate hospital costs for four high-volume conditions—acute myocardial infarction (AMI), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia. Among initial hospital stays (index stays) for AMI, CHF, COPD, and pneumonia, the aggregate cost of readmissions in 2013 was $5.2 billion for Medicare—74 percent of the aggregate cost of readmissions for these four conditions. From 2009 to 2013, the readmission rate for stays covered by Medicare decreased by 13 percent for AMI, by 7 percent each for CHF and COPD, and by 6 percent for pneumonia. Overall, the largest decrease in readmission rate from 2009 to 2013 was for AMI (by 13 percent, from 16.9 to 14.7 readmissions per 100 index stays for AMI). Although the rate declined overall (across payers), the aggregate cost of readmissions following an index stay for AMI decreased only among index stays covered by private insurance (by 18 percent). Although Medicare was the only payer for which the rate of readmission for pneumonia decreased from 2009 to 2013, the aggregate cost of readmissions for pneumonia decreased for all payers, by 6-26 percent. The aggregate cost of readmissions following an index stay for any of the four conditions decreased from 2009 to 2013 for all payers, except the uninsured whose rate remain unchanged. The largest declines were for index stays paid by private insurance (22 percent) and Medicare (9 percent).

November 2015

Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013

Kathryn Fingar, Ph.D., M.P.H., and Raynard Washington, Ph.D.



Introduction

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).¹ 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.² In addition to these costs, repeat hospitalizations place patients at greater risk for complications, hospital acquired infections, and stress.³ Because the majority of readmissions are for nonsurgical services, it is unlikely that readmissions are profitable for hospitals.⁴

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.⁵

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. In 2015, penalties also will be calculated based on readmissions for chronic obstructive pulmonary disease (COPD) and hip and knee replacements.⁶ CMS includes these conditions and procedures because of their high volume and costs.⁷

This Healthcare Cost and Utilization Project (HCUP) Statistical Brief examines trends from 2009 through 2013 for all readmissions following an admission for any cause, as well as for readmissions following an admission for four high-volume conditions targeted by the HRRP: AMI, CHF, COPD, and pneumonia. Readmission was defined as a subsequent hospital admission for any cause within 30 days following an initial hospital admission, referred to as the index stay. Because all-cause readmissions were examined, readmissions may or may not be related to the primary reason for admission during the index stay. Trends in the rate and aggregate cost of readmissions were examined overall and by expected payer of the index stay. Therefore, the expected payer of the readmission may be different from that of the index stay. Aggregate costs are those for the readmission only, not counting the cost of the index stay. Differences of greater than 5 percent are noted in the text.

Findings

Readmission rates among high-volume conditions, 2013
Table 1 presents conditions with at least 250,000 index stays that had the highest rate of readmission for all causes within 30 days in 2013. The four highlighted conditions-AMI, CHF, COPD, and pneumonia—are the focus of this Statistical Brief.