What is the most common diagnosis that leads to hospital readmission?
Diagnoses at index stays with the highest 7-day and 30-day readmission rates were similar. Schizophrenia, alcohol-related disorders, and congestive heart failure were among the leading diagnoses with both the highest 7-day and 30-day readmission rates.
How is the 30-day readmission rate for a hospital determined?
Each hospital stay has one assigned DRG. The 30-day readmission rate is defined as the number of admissions for each condition for which there was at least one subsequent hospital admission within 30 days, divided by the total number of admissions from January through November of the same year.
What percentage of hospital readmissions are covered by Medicare?
Across all expected payers in 2018, there were 3.8 million readmissions, of which Medicare accounted for 60.3 percent (2.3 million) and Medicaid accounted for 19.0 percent (721,300).
Which patients with schizophrenia have the highest readmission rates?
Index stays with schizophrenia and other psychotic disorders had the highest rate of readmission within 7 days for patients with Medicare (9.3 per 100 index stays), Medicaid (9.9), and those who were uninsured (7.4).
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).
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 does readmission within 30 days with the same diagnosis mean?
Readmissions during the 30-day period that follow a planned readmission are not counted in the outcome. In the case of multiple readmissions during the 30-day period, the measure counts only one outcome. Readmissions to the same hospital on the same day for the same principal diagnosis are not counted in the outcome.
What percentage of 30-day readmission rates for Medicare beneficiaries are unplanned?
Unplanned readmissions accounted for 90.1 percent of all-cause readmissions. The observed thirty-day unplanned readmission rate was 17.5 percent for acute myocardial infarction, 23.6 percent for heart failure, 17.6 percent for pneumonia, and 15.5 percent for hospital-wide all-cause, unplanned readmissions.
What causes high readmission rates?
1. Disengagement and Non-Compliance. Disengagement refers to a patient's disinterest or unwillingness to participate in their care, and non-compliance means they are not following their treatment plan. Disengagement and non-compliance are the top causes of preventable readmissions.
What is the leading cause of hospital readmissions?
Health Condition A study conducted by the Agency for Healthcare Research and Quality (AHRQ) on readmissions from 2018 identified septicemia as the top cause of readmissions among Medicare patients, followed by congestive heart failure, COPD, pneumonia and renal failure.
What is the Medicare 30-day readmission rule?
Policy statement. Readmission to the same hospital (assigned provider identifier by our health plan) within 30 days of discharge of the initial admission is subject to clinical review to determine if the readmission is related to or similar to the initial admission.
How is the 30-day readmission rate calculated?
The Observed Readmission Rate is the percentage of acute inpatient stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days. It is equal to the Count of 30-Day Readmissions (Column 2) divided by the Count of Index Hospital Stays (Column 1).
What is the Medicare readmission program?
The Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.
What is Medicare readmission rate?
30-Day Readmission Rates 16.3% for pneumonia) (Table 1). However, after risk adjustment, the readmission rates were higher for patients in Medicare Advantage (17.2% vs. 16.9% for AMI, 21.7% vs. 21.4% for CHF, and 16.5% vs.
What is the readmission rate for heart failure?
Nearly 1 in 4 heart failure (HF) patients are readmitted within 30 days of discharge and approximately half are readmitted within 6 months. It has been suggested that about one quarter of HF readmissions may be preventable.
What percent of readmissions are avoidable?
“Research suggests that 25 percent of all readmissions are preventable, so what we've been able to demonstrate in this first year working with our partners at Independence is that we can implement strategies that substantially reduce our readmission rates and improve overall patient care,” said Patrick J.
How long does it take for a Medicare patient to be readmitted?
Among patients with Medicare or Medicaid who were discharged with one of these three conditions at the index stay, between 1 in 4 and 1 in 5 stays resulted in readmission within 30 days. The 7-day readmission rate was also highest for patients with Medicare or Medicaid.
How long is a hospital readmission?
The 30-day readmission rate is defined as the number of admissions for each condition for which there was at least one subsequent hospital admission within 7 or 30 days, divided by the total number of admissions from January through November of the same year.
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.
What is the Hospital Readmissions Reduction Program?
HRRP is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better engage patients and caregivers in discharge plans and, in turn, reduce avoidable readmissions.
Why is the Hospital Readmissions Reduction Program important?
HRRP improves Americans’ health care by linking payment to the quality of hospital care. CMS incentivizes hospitals to improve communication and care coordination efforts to better engage patients and caregivers on post-discharge planning.
What are applicable Hospital Readmissions Reduction Program hospitals?
Section 1886 (d) (1) (B) of the Social Security Act defines applicable hospitals under HRRP.
What measures are included in the Hospital Readmissions Reduction Program?
We use the excess readmission ratio (ERR) to assess hospital performance. The ERR measures a hospital’s relative performance and is a ratio of the predicted-to-expected readmissions rates. We calculate an ERR for each condition or procedure included in the program:
What counts as a readmission under the Hospital Readmissions Reduction Program?
The HRRP 30-day risk standardized unplanned readmission measures include:
How does the Hospital Readmissions Reduction Program adjust payments?
For each eligible hospital, we calculate the payment adjustment factor. The payment adjustment factor corresponds to the percent a hospital’s payment is reduced. The payment adjustment factor is a weighted average of a hospital's performance across the six HRRP measures during the HRRP performance period.
What is the Review and Correction 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.
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.
What is readmission for any reason?
Furthermore, readmission for any reason exposes the patient to risks associated with hospitalization, such as iatrogenic errors. Second, there is no reliable way to determine whether a readmission is related to the previous hospitalization based on the documented cause of readmission. For example, a stroke patient who develops aspiration pneumonia may ultimately be readmitted for respiratory distress. It would be inappropriate to treat this readmission as unrelated to the care the patient received for stroke. Third, the range of potentially avoidable readmissions also includes those not directly related to the index condition category, such as those resulting from medication reconciliation errors, poor communication at discharge, or inadequate follow-up post-discharge. Creating a comprehensive list of potentially avoidable readmissions related to the previous hospitalization’s condition category would be arbitrary and, ultimately, challenging to implement. Fourth, all existing CMS readmission measures report all-cause readmission, making this approach consistent with existing measures. Fifth, research shows that readmission reduction interventions can reduce all-cause readmission, not only condition-specific readmission. Finally, defining the outcome as all-cause readmissions may encourage hospitals to implement broader initiatives aimed at improving the overall care within the hospital and transitions from the hospital setting instead of limiting the focus to a narrow set of condition-specific approaches. The goal of this measure is not to reduce readmissions to zero, but to assess hospital performance relative to what is expected given the performance of other hospitals with similar case mixes.
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%.