News Feature | April 28, 2014

Federal Report Sheds Light On Readmission Rates

Christine Kern

By Christine Kern, contributing writer

Federal Healthcare Readmission Rate Report

30-Day Readmission Rates Differ by Insurance Category, Disease

A new report from the Agency for Healthcare Research and Quality provides insight for hospitals struggling to reduce 30-day readmissions.  It lists the top conditions associated with approximately 3.3 million readmissions in 2011 and analyzes how conditions vary depending on insurance coverage.

Researchers used readmissions data from AHRQ’s Healthcare Cost and Utilization Project, which is a set of healthcare databases and tools. Readmissions in 2011 contributed $41.3 billion in total hospital costs. The study covered Medicare beneficiaries aged 65 and older, and individuals aged 18-64 who were privately insured, covered by Medicaid or uninsured.

Some highlights from the report’s findings:

  • There were approximately 3.3 million adult hospital readmissions in the U.S., costing $41.3 billion.
  • Medicare patient readmissions saw the most readmissions for congestive heart failure (134,500 readmissions), septicemia (92,900 readmissions), and pneumonia (88,800), costing $4.3 billion.
  • Medicaid patient readmissions saw the most readmissions for mood disorders (41,600), schizophrenia (35,800), and diabetes (23,700), resulting in $839 million.
  • Privately insured patient readmissions was the largest readmission rates for maintenance chemotherapy (25,500), mood disorders (19,600), and complications from surgical or medical care (18,000), resulting in $785 million.

According to the report, Medicare had far more readmissions with 55.9 percent of the total, and 58.2 percent of associated costs. Comparatively, Medicaid had 20.6 percent of readmissions and 18.4 percent of costs, while private insurance accounted for 18.6 percent of readmissions and 19.6 percent of costs and the uninsured covered 4.9 percent of admissions and 3.7 percent of costs.

Overall, the readmission rates per 100 admissions were 17.2 for Medicare, 14.6 for Medicaid, 8.7 for privately insured, and 10.6 for uninsured. The report argued that “identifying conditions that contribute the most to the total number of readmissions and related costs for all payers may aid health care stakeholders in deciding which conditions to target to maximize quality improvement and cost-reduction efforts.”