Patients who are deconditioned and have medically complex diagnoses have the highest 30-day readmission among the 6 largest rehabilitation impairment categories (RICs). 4 Rehabilitation impairment categories are clinically homogeneous diagnosis groupings that represent the primary reason for the rehabilitation stay.
Is there a measure for 30‐day readmission following hospitalization for Medicare beneficiaries?
In this draft measure methodology report, we present a measure for 30‐day readmission following hospitalization for any condition that is based on administrative claims data for FFS Medicare beneficiaries 65 years and older.
Which diagnoses have the highest 7-day readmission rates?
Schizophrenia also is among the top five diagnoses with the highest 7-day readmission rates for each payer category. Figure 3. All-cause 7-day and 30-day readmission rates following index stays for three select conditions, by expected payer, 2014
What is included in patient readmission rates?
Readmissions include stays for all causes, including planned and unplanned stays. Readmission rates reported by diagnoses reflect the principal diagnosis at the index (i.e., initial) inpatient stay, grouped into broad clinical categories.
How much would reducing readmission rates save Medicare?
A 2006 Commonwealth Fund report estimated that if national readmission rates were lowered to the levels achieved by the top-performing regions, Medicare would save $1.9 billion annually. 2
What diagnosis has the highest readmission rate?
Among these most frequent conditions, the highest readmission rates were seen for congestive heart failure (24.7 percent), schizophrenia (22.3 percent), and acute and unspecified renal failure (21.7 percent). In other words, for these conditions over one in five patients were readmitted to the hospital within 30 days.
What are the most common causes of readmission?
10 Common Causes for Hospital ReadmissionsMedication errors or lack of accurate medication history. ... Medication noncompliance by the patient. ... Fall injuries. ... Lack of timely follow-up care. ... Failure to identify post-acute care needs. ... Inadequate nutrition. ... Lack of transportation to access care. ... Infection.More items...
What issues may lead to readmission within 30 days?
Readmission to acute hospital diagnoses The most common reasons for readmission for patients readmitted within 30 days were chest infection (n = 20), stroke (n = 14) and falls/immobility (n = 13).
What causes high readmission rates?
Disengagement and non-compliance are the top causes of preventable readmissions. Patients who don't understand the importance of their treatments or don't take them seriously may ignore their discharge instructions.
What is the highest risk for readmission following an inpatient discharge?
Conclusion. Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit.
What is the most significant cause for preventable hospital readmissions?
More than half of these readmissions (140 of 269 cases, 52.0%) were determined to be potentially preventable because of “gaps in care during the initial inpatient stay.” Premature discharge from the hospital was a key factor leading to preventable readmissions.
What are 3 chronic health conditions that a person might have that would trigger a penalty for a readmission?
If Readmissions Are Down, Why Are Penalties Up?Heart attack.Heart failure.Pneumonia.Chronic obstructive pulmonary disease (COPD)Coronary artery bypass graft surgery.Elective total hip and total knee replacements.
What is the most significant reason for healthcare staff to prevent readmissions?
Reducing hospital readmissions—especially those that result from poor inpatient or outpatient care—has long been a health policy goal because it represents an opportunity to lower health care costs, improve quality, and increase patient satisfaction at once.
Why are patients readmitted to the hospital?
Readmissions following hospital discharge are common and used by many individuals and organizations as a measure of the quality of care provided by physicians and hospitals. As reported by the Centers for Medicare Services,4 approximately 1 in 5 patients are readmitted to the hospital within 30 days of discharge.
How do chronic conditions relate to hospital readmissions?
Conclusion. Readmission in chronic conditions is very common and often caused by diseases other than the index hospitalisation. Interventions to reduce readmissions should therefore focus not only on the primary condition but on a holistic consideration of all the patient's comorbidities.
What percentage of Medicare patients are readmitted to the hospital within 30 days of discharge for any reason?
The results of the study are also consistent with MedPAC's 2008 report, which said 18 percent of Medicare hospitalizations result in readmissions within 30 days of discharge.
What is a primary driver for preventing avoidable 30-day hospital readmissions?
“One common factor among the five most effective program types was that the primary driver of the intervention's success was the patient,” Kash said. “Although hospitals and providers play a key part in organizing and managing these interventions, patients must take an active role in each one.
What are the rates of readmission?
For both 7-day and 30-day readmissions, the rate of readmission was highest among patients covered by: 1 Medicare (6.1 and 17.3 per 100 index stays, respectively), 2 Medicaid (5.0 and 13.7), 3 no insurance (4.5 and 11.5), and 4 private insurance (3.3 and 8.9)
How long after discharge should readmissions be?
Readmissions were higher within the first several days after discharge reaching the lowest point around seven days. This suggest that a five-to-seven-day interval would better capture hospital-attributable readmissions, particularly when compared to intervals of 30, 60, or 90 days.
How many Medicare index stays are there?
Only CCS with at least 50,000 Medicare index stays, 20,000 Medicaid index stays, 25,000 privately insured index stays, and 5,000 uninsured index stays are shown. “Other” CCS that group a nonspecific set of diagnoses, as well as diagnoses related to cancer and pregnancy, are excluded.
How much would Medicare save if readmission rates were lowered?
A 2006 Commonwealth Fund report estimated that if national readmission rates were lowered to the levels achieved by the top-performing regions, Medicare would save $1.9 billion annually.
What is a 30 day readmission?
This measure reports the hospital-level, risk-standardized rate of unplanned all-cause readmission after admission for any condition within 30 days of hospital discharge. The measure comprises a single summary score, derived from the results of seven different models, one for each of the following cohorts (groups of discharge condition categories or procedure categories): general medicine, surgery/gynecology, cardiorespiratory, cardiovascular, neurology, oncology, and psychiatry, each of which will be described in greater detail below. The measure uses one year of data.
Why are readmissions unavoidable?
contribute substantially to loss of functional ability, particularly in older patients. Some readmissions are unavoidable and result from inevitable progression of disease or worsening of chronic conditions. However, readmissions may also result from poor quality of care or inadequate transitional care. Transitional care includes effective discharge planning, transfer of information at the time of discharge, patient assessment and education, and coordination of care and monitoring in the post-discharge period. Numerous studies have found an association between quality of inpatient or transitional care and early (typically 30-day) readmission rates for a wide range of conditions.
Why are readmissions important?
Readmissions are also a major source of patient and family stress and may contribute substantially to loss of functional ability, particularly in older patients. Some readmissions are unavoidable and result from inevitable progression of disease or worsening of chronic conditions. However, readmissions may also result from poor quality of care or inadequate transitional care. Transitional care includes effective discharge planning, transfer of information at the time of discharge, patient assessment and education, and coordination of care and monitoring in the post-discharge period. Numerous studies have found an association between quality of inpatient or transitional care and early (typically 30-day) readmission rates for a wide range of conditions. 11-18 Therefore, while readmission rates would never be expected to be zero, variation in readmission rates for a broad spectrum of conditions is related to quality of care. Furthermore, randomized controlled trials have shown that improvement in the following areas can directly reduce readmission rates: quality of care during the initial admission; improvement in communication with patients, their caregivers and their clinicians; patient education; predischarge assessment; and coordination of care after discharge.20-35 Evidence that hospitals have been able to reduce readmission rates through these quality-of-care initiatives illustrates the degree to which hospital practices can affect readmission rates. Successful randomized trials have reduced 30-day readmission rates by 20-40%.
How long does it take to readmit a patient?
An intentional readmission within 30 days of discharge from an acute care hospital that is a scheduled part of the patient’s plan of care. Planned readmissions are not counted as outcomes in this measure (see
How does quality of care affect readmission rates?
in readmission rates for a broad spectrum of conditions is related to quality of care. Furthermore, randomized controlled trials have shown that improvement in the following areas can directly reduce readmission rates: quality of care during the initial admission; improvement in communication with patients, their caregivers and their clinicians; patient education; predischarge assessment; and coordination of care after discharge.
What is a hospital-wide readmission measure?
By contrast, a hospital-wide, all-condition readmission measure could provide a broader assessment of the quality of care at hospitals. Therefore, CMS has contracted with Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation (YNHHSC/CORE) to develop a claims-based, risk adjusted hospital-wide readmission (HWR) measure for public reporting that reflects the quality of care for hospitalized patients in the United States. In this technical report we provide
How long does it take for an unplanned readmission to happen?
Unplanned readmissions that happen within 30 days of discharge from the index (i.e., initial) admission. Patients who are readmitted to the same hospital, or another applicable acute care hospital for any reason. Readmissions to any applicable acute care hospital are counted, no matter what the principal diagnosis was.
Why does CMS exempt Maryland hospitals from HRRP payment reductions?
CMS exempts Maryland hospitals from HRRP payment reductions because an agreement between CMS and Maryland.
How long is the HRRP review period?
The 30-day Review and Correction period allows applicable hospitals to review and correct their HRRP Payment Reduction and component result calculations as reflected in their HSR (i.e., Payment Adjustment Factor, Dual Proportion, Peer Group Assignment, Neutrality Modifier, ERR, and Peer Group Median ERRs) prior to them being used to adjust payments. Hospitals can’t submit corrections to the underlying claims data or add new claims to the data extract during this period.
Is readmission counted as a diagnosis?
Readmissions to any applicable acute care hospital are counted, no matter what the principal diagnosis was. The measures exclude some planned readmissions.