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Medicaid Hospital Readmissions

By September 5, 2014Commentary

Much of the focus on hospital readmissions has been in regard to the CMS program for Medicare beneficiaries.  A study in Health Affairs looks at hospital readmissions in the Medicaid program.   (HA Article)   Medicaid is now the single largest payer in the US, with 62 million covered persons, and more on the way under the reform law expansions.  The current research was a background study designed to help understand the depth of the readmission issue in Medicaid and for formulation of policy.  The data source was claims data from 19 states, generally from 2010, and only included people under 65, to avoid dual eligible issues.  The total sample was about 2,672,000 admissions, of which a little over 250,000, or 9.4% were readmissions within thirty days of a prior hospital admission discharge.  There was substantial variation in the readmission rate among states, from 5.5% to 11.9%.  The rate for adults over 20 was 12.8% and for people aged 0 to 20 it was 5.4%.  Males had higher readmission rates than did females.  The older a cohort, the higher the readmission rate.  On average the readmissions cost a state $77 million, 12.5% of all Medicaid payments for hospitalizations.  While pregnancy and childbirth accounted for the single largest share of admissions, they had the lowest readmission rate among diagnostic categories, but because of the number of admissions, still accounted for the second most source of readmissions.  The single largest diagnostic contributor to readmissions were mental health issues, accounting for almost 20% of the total, with respiratory, digestive and circulatory disorders also in the top five contributors.   Most of the states had some program related to Medicaid readmissions, with 12 having nonpayment policies in some cases, but most of these policies had been implemented too recently to show an effect in the analysis.   The study suggests that Medicaid can benefit by improving care coordination and primary care for common chronic disease and by focussing on mental health care.

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