IHD Journal Watch: Conditions Causing the Most Readmissions

Conditions Causing the Most Readmissions

Hines AL, Barrett ML, Jiang HJ, Steiner CA. Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011. Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Statistical Brief #172, www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf.

Introduction

Healthcare reform has pinpointed hospital readmissions as a key area for improving care coordination and achieving potential savings. Stakeholders are using data to devise strategies to reduce readmissions. Two criteria for evaluating potential areas of impact include volume and costs. For example, the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program has selected acute myocardial infarction, heart failure, and pneumonia as target areas for the Medicare population. CMS chose these conditions, in part, because of their high prevalence and their associated high costs for total admissions and readmissions among Medicare beneficiaries. In 2015, CMS will expand their assessment of readmissions to additional conditions that represent high volume and costs.

Identifying conditions that contribute the most to the total number of readmissions and related costs for all payers may aid healthcare stakeholders in deciding which conditions to target to maximize quality improvement and cost-reduction efforts. This Statistical Brief uses readmissions data from the Healthcare Cost and Utilization Project (HCUP) to present the conditions with the largest number of 30-day all-cause readmissions among U.S. hospitals in 2011 and their associated costs. We limited the study population to Medicare beneficiaries aged 65 years and older and to individuals aged 18–64 years who were privately insured, uninsured, or covered by Medicaid.

Findings

Overview of hospital readmissions and related costs by payer—In 2011, there were approximately 3.3 million readmissions in the United States across all payers in the study population. Readmissions contributed $41.3 billion in total hospital costs. Medicare had the largest share of total readmissions (55.9%) and associated costs for readmissions (58.2%). Medicaid had the second-largest share of total readmissions (20.6%) and represented a lower share of associated costs (18.4%). Private insurance had a much smaller share of total readmissions (18.6%) and the second-highest associated costs (19.6%). The uninsured represented the smallest proportion of the hospital population overall, accounting for only 4.9% of total readmissions and 3.7% of costs. Overall, readmission rates per 100 admissions in this study population ranged from 8.7 for the privately insured to 17.2 for Medicare beneficiaries.

Conditions that resulted in the most readmissions for Medicare patients, 2011—Three conditions currently targeted by the CMS Hospital Readmissions Reduction Program rank among the top 10 conditions identified here (see Table 1). These include congestive heart failure (134,500 readmissions; $1.7 billion in total costs), pneumonia (88,800 readmissions; $1.1 billion in total costs), and acute myocardial infarction (51,300 readmissions; $693 million in total costs). The top 10 conditions include additional chronic conditions such as cardiac dysrhythmias, acute cerebrovascular disease, and chronic obstructive pulmonary disease and bronchiectasis. Two infectious conditions also ranked among the conditions with the most readmissions. Septicemia contributed 92,900 readmissions, and urinary tract infections contributed 56,900 readmissions.

Conditions that resulted in the most readmissions for Medicaid patients, 2011—Four mental health or substance use disorders were among the conditions resulting in the most all-cause, 30-day readmissions for Medicaid patients. These conditions included mood disorders, schizophrenia and other psychotic disorders, alcohol-related disorders, and substance-related disorders. They resulted in a total of 113,100 readmissions and $832 million in hospital costs. Complications of pregnancy and early or threatened labor among Medicaid patients resulted in 21,500 readmissions and 19,000 readmissions, respectively.

Conditions that resulted in the most readmissions for privately insured patients, 2011—Readmissions for privately insured patients spanned broadly across various body systems relative to Medicare- and Medicaid-covered patients. Maintenance chemotherapy accounted for the largest share of readmissions (4.2%) among privately insured patients; however, it should be noted that these were most likely planned readmissions for cancer treatment. Mood disorders resulted in 19,600 readmissions (3.2% of privately insured readmissions). Healthcare complications among the privately insured resulted in 49,700 readmissions and $844 million in costs. These conditions included complications of surgical procedures or medical care, complications of a device or graft, and septicemia.

Conditions that resulted in the most readmissions for uninsured patients, 2011—Four conditions related to mental health or substance use disorders resulted in 28,400 readmissions and $165 million in costs: mood disorders, alcohol-related disorders, schizophrenia and other psychotic disorders, and substance-related disorders. Three circulatory conditions—nonspecific chest pain, congestive heart failure and acute myocardial infarction—resulted in a total of 11,100 readmissions and $117 million in costs.

Bullet points:

• In 2011, there were approximately 3.3 million readmissions in the United States across the study population. These contributed $41.3 billion in total hospital costs.

• Identifying conditions that contribute the most to the total number of readmissions and related costs may aid stakeholders in deciding which conditions to target to maximize quality improvement and cost-reduction efforts.