Okay, so hospital readmissions are bad and we should prevent them. A good first step is understanding what diagnoses are most often related to readmissions. An Agency for Healthcare Research & Quality Statistical Brief gives us 2011 data, broken down by payer type. (Stat. Brief) In 2011 there were 3.3 million all-cause readmissions within thirty days after a hospital discharge. These readmissions cost $41.3 billion but it is important to remember that not all these readmissions are inappropriate or avoidable. Some are actually planned, for example, for follow-up procedures. And the all-cause readmission measure means many of the subsequent readmissions were for problems unrelated to the original admission. For Medicare, the largest admission diagnoses followed by a readmission were congestive heart failure, 135,000 readmissions; septicemia, 92,000 readmissions; and pneumonia, 88,000 readmissions. These readmissions represented $4.3 billion in hospital costs and over 17% of all Medicare readmissions. For Medicaid, adult readmissions followed mood disorders, 41,600, most commonly, followed by schizophrenia, 35,800, and diabetes 23,700 readmissions. These represented 15% of all Medicaid readmissions. For privately insured people the highest admission followed by readmission was maintenance chemotherapy at 25,500, almost none of which are likely avoidable; mood disorders, 19,600, and complications of surgical or medical care, 18,000 readmissions, most of which we suspect were avoidable. These three diagnoses accounted for only about 10% of all commercial readmissions. The high number of mental illness related readmissions in Medicaid and private insurance are likely signs of poor outpatient care, especially a failure to ensure that a medication regiment is appropriate and adhered to. For uninsured patients, the diagnoses are similar to those in Medicaid, with mood disorders first at 12,200; alcoholism at 8,800 and diabetes at 7,400, with these being about 18% of all uninsured patient readmissions. This data, which hospitals and payers should already have access to, should help target readmission prevention efforts.
Hospital Readmission Causes and Costs
By Kevin RocheMay 7, 2014Commentary
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About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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