Given the intense focus on preventing hospital readmissions over the last few years, it would obviously be of interest to see if the number and cost of readmissions has changed much over that time period and that is exactly the subject of a new Agency for Healthcare Research & Quality brief. (AHRQ Brief) The data comes from the HCUP project, which collects data from hospitals and state agencies in most states, and covers 2009-2013. For Medicare, which has the highest rate, from 2009 to 2013 the rate declined from 18.1 readmissions per 100 admissions to 17.3, with all the decline coming in 2012 and 2013. At the other end of the spectrum for private insurers the rate was essentially flat, 8.7 in 2009, 8.6 in 2013. Medicaid was also basically flat, from 14 to 13.9, while the uninsured saw an uptick, from 10.2 to 11.1 in this time. So across all payers, the readmission rate was essentially unchanged, going in this time period from 14 to 13.9. It is not broken out in the data, but be useful to see how Medicare Advantage compared to fee-for-service Medicare, with the suspicion being that the decline has occurred in MA. The actual number of readmissions declined more rapidly in most categories, as hospital admissions were generally decreasing in this period. Private insurers experienced the greatest decline in the number of readmissions. For all payers, readmissions cost more than the index admission; 5.3% more for Medicare, 30% more for Medicaid, 32% more for private insurance and 11% more for the uninsured. This indicates some serious problem that occurred between the two admissions, not just that the patient needed a little more time to recuperate. This set of data suggest little progress in reducing the rate of readmissions, although the absolute number has declined. It also would indicate that probably most readmissions were not avoidable.
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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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