miércoles, 14 de septiembre de 2016

CMS Blog: New data: 49 states plus DC reduce avoidable hospital readmissions

Centers for Medicare & Medicaid Services


September 7, 2016
By Patrick Conway, M.D., principal deputy administrator and chief medical officer, CMS; and Tim Gronniger, deputy chief of staff, CMS
The unfortunate experience of having to return to the hospital after recently being treated—or watching the same thing happen to a friend or family member—is all too common. Potentially avoidable hospital readmissions that occur within 30 days of a patient’s initial discharge are estimated to account for more than $17 billion in Medicare expenditures annually.[1]  Not only are readmissions costly, but they are often a sign of poor quality care. Many readmissions can be avoided through improvements in care, such as making sure that patients leave the hospital with appropriate medications, instructions for follow-up care, and follow-up appointments scheduled to make sure their recovery stays on track.

To address the problem of avoidable readmissions, the Affordable Care Act created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions such as heart attacks, heart failure, and pneumonia. The Centers for Medicare & Medicaid Services has also undertaken other major quality improvement initiatives, such as the Partnership for Patients, which aim to make hospital care safer and improve the quality of care for individuals as they move from one health care setting to another.

The data show that these efforts are working. As described below, between 2010 and 2015, readmission rates fell by 8 percent nationally. Today, CMS is releasing new data showing how these improvements are helping Medicare patients across all 50 states and the District of Columbia. The data show that since 2010: 
  • All states but one have seen Medicare 30-day readmission rates fall.[2]
  • In 43 states, readmission rates fell by more than 5 percent.
  • In 11 states, readmission rates fell by more than 10 percent.

Readmissions Data 

Across states, Medicare beneficiaries avoided almost 104,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels. That means Medicare beneficiaries collectively avoided 104,000 unnecessary return trips to the hospital. Cumulatively since 2010, the HHS Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions.

The Hospital Readmissions Reduction Program is just one part of the Administration’s broader strategy to reform the health care system by  paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality. Other initiatives include Accountable Care Organizations, as well as efforts by Quality Improvement Organizations and Hospital Engagement Networks, which fund quality improvement expert consultants to work with provider and hospital communities to improve care. The goal of all of these efforts is to spend our health care dollars more wisely to promote better care for Medicare beneficiaries and other Americans across the country.
State20102015% Change in Readmission RatesReduction in readmissionsin 2015 compared to 2010
Hospital AdmissionsReadmission RateHospital AdmissionsReadmission Rate
AK
9,809
14.50%
9,954
13.70%
-5.50%
-78
AL
154,856
17.20%
143,210
16.20%
-5.80%
-1,503
AR
103,056
17.70%
92,562
16.60%
-6.20%
-993
AZ
135,293
16.60%
128,061
14.80%
-10.80%
-2,270
CA
574,176
17.60%
547,558
16.60%
-5.70%
-5,580
CO
83,346
14.20%
81,822
12.90%
-9.20%
-1,099
CT
109,888
18.10%
96,492
16.70%
-7.70%
-1,306
DC
23,907
20.00%
23,194
18.50%
-7.50%
-346
DE
29,827
17.40%
32,257
15.60%
-10.30%
-575
FL
619,368
18.20%
588,187
17.70%
-2.70%
-3,161
GA
209,500
17.50%
191,485
16.20%
-7.40%
-2,453
HI
16,824
14.90%
15,799
12.90%
-13.40%
-315
IA
100,490
15.50%
91,256
14.50%
-6.50%
-910
ID
25,432
12.50%
28,139
12.20%
-2.40%
-78
IL
421,395
19.80%
335,610
17.40%
-12.10%
-8,108
IN
210,919
17.40%
186,241
16.10%
-7.50%
-2,474
KS
90,545
16.30%
87,224
14.70%
-9.80%
-1,361
KY
162,249
19.70%
132,511
17.90%
-9.10%
-2,384
LA
129,123
18.70%
112,328
16.90%
-9.60%
-2,013
MA
208,356
19.00%
197,649
17.90%
-5.80%
-2,213
MD
189,323
21.10%
170,510
18.90%
-10.40%
-3,789
ME
43,450
16.10%
38,571
15.50%
-3.70%
-232
MI
343,346
18.60%
280,152
18.00%
-3.20%
-1,767
MN
129,642
15.70%
130,725
14.60%
-7.00%
-1,435
MO
203,685
18.20%
174,677
16.90%
-7.10%
-2,311
MS
106,281
19.10%
96,252
17.60%
-7.90%
-1,469
MT
27,962
13.90%
27,518
13.10%
-5.80%
-231
NC
269,108
17.00%
235,283
15.90%
-6.50%
-2,472
ND
26,562
15.40%
26,650
14.40%
-6.50%
-267
NE
60,007
15.70%
56,791
14.40%
-8.30%
-735
NH
36,189
15.70%
39,871
15.30%
-2.50%
-152
NJ
281,282
20.30%
250,924
17.60%
-13.30%
-6,774
NM
36,209
15.20%
33,016
14.80%
-2.60%
-118
NV
51,787
18.00%
52,308
17.00%
-5.60%
-529
NY
491,897
19.90%
402,439
17.80%
-10.60%
-8,407
OH
325,091
18.80%
267,743
16.80%
-10.60%
-5,405
OK
119,346
17.40%
106,073
15.60%
-10.30%
-1,878
OR
58,182
14.30%
61,393
14.20%
-0.70%
-75
PA
369,418
18.10%
324,166
16.60%
-8.30%
-4,995
RI
24,142
19.00%
24,705
17.00%
-10.50%
-487
SC
130,950
16.50%
125,993
15.50%
-6.10%
-1,237
SD
31,269
14.90%
30,806
13.20%
-11.40%
-515
TN
207,875
18.40%
180,666
16.80%
-8.70%
-2,905
TX
571,147
17.10%
509,738
16.10%
-5.80%
-4,960
UT
33,534
12.20%
38,142
11.50%
-5.70%
-261
VA
207,241
17.50%
211,674
16.40%
-6.30%
-2,302
VT
15,439
15.30%
16,332
15.40%
0.70%
21
WA
130,798
15.30%
131,817
14.20%
-7.20%
-1,388
WI
137,336
15.60%
124,274
14.50%
-7.10%
-1,373
WV
70,144
19.90%
60,630
18.60%
-6.50%
-777
WY
13,277
15.10%
12,838
14.20%
-6.00%
-110



[1] Jencks, S. F., Williams, M. V. and Coleman, E. A. (2009). 'Rehospitalizations among patients in the Medicare fee-for-service program'. New England Journal of Medicine, 360 (14), 1418-1428.
[2] The readmission rate in Vermont was virtually unchanged, increasing slightly from 15.3% in 2010 to 15.4% in 2015. This change correlates to 21 additional readmissions compared to if the state’s rate had remained constant.

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