what is the readmission rates for medicare beneficiaries

by Eusebio Ryan Published 2 years ago Updated 1 year ago

Key Findings Race and ethnicity, dual eligibility, and potentially disabling condition status were associated with Medicare fee-for-services beneficiaries’ 30-day readmissions. The readmission rate by race and ethnicity ranged from 13.8% among non-Hispanic White beneficiaries to 19.4% among non- Hispanic Black beneficiaries.

Systematic reviews have reported that 30-day readmission rates range from 11% to 23% among elderly Medicare beneficiaries. The Medicare Payment Advisory Commission (MedPAC), which regularly monitors readmissions among Medicare beneficiaries, found that three quarters of such readmissions might be avoidable.

Full Answer

Why are hospital readmissions bad?

4 rows · Jul 16, 2019 · For AMI, the 30-day readmission rate was 0.2 percentage point (CI, −0.2 to 0.6 percentage point) ...

How to use telehealth to reduce readmission rates?

However, among index admissions appearing in HEDIS, 14.4% for AMI, 18.4% for CHF, and 13.9% for pneumonia resulted in a readmission. Patients in Medicare Advantage had lower unadjusted readmission rates than those in traditional Medicare for all 3 conditions (16.6% vs. 17.1% for AMI, 21.4% vs. 21.7% for CHF, and 16.3% vs. 16.4% for pneumonia).

What is the new Medicare rate?

Jul 16, 2021 · The hazard ratio for 30-day readmission was 0.47 (95% confidence interval [CI] 0.33-0.68, P<0.0001). The hazard ratio for 1-year readmission was 1.45 (95% CI 1.19-1.76, P<0.001). Conclusions:This is one of the first studies of …

How do readmission rates affect revenue?

May 02, 2012 · Under Medicare's Inpatient Prospective Payment System (IPPS), as included in the Affordable Care Act (ACA), there will be adjustments to payments made for excessive readmissions in acute care hospitals during fiscal years beginning on or after October 1, 2012. A readmission is defined as: being admitted at the same or different hospital within ...

What is Medicare readmission rate?

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).Jul 15, 2021

How many Medicare beneficiaries are readmitted within 30 days every year?

The study found that 19.6% of beneficiaries were readmitted within 30 days of their initial discharge, 34% within 90 days and 56.1% within 12 months (Shelton, Chicago Tribune , 4/1).Jun 11, 2009

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 percentage of patients are readmitted?

The study also found that 34 percent of patients are readmitted within 90 days while 56 percent of patients are readmitted within one year. These rehospitalizations cost Medicare an estimated $17.4 billion in 2004, according to the study.Apr 3, 2009

What is the hospital readmissions reduction 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.Dec 1, 2021

What factors contribute to hospital readmissions among older adults?

The reasons which account for hospital readmission are generally related to health-care factors (such as sub-optimal health and social care), factors related to the patient (social and family environment or treatment adherence), factors related to the disease (such as its natural progression) or a combination of all of ...May 10, 2011

How do you calculate readmission rate?

Readmission rate: number of readmissions (numerator) divided by number of discharges (denominator); each readmission should be counted only once to avoid skewing the rate with multiple counts.

What is the Medicare 30-day readmission rule?

Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery. A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.

Does Medicare penalize hospitals for readmissions?

For the readmission penalties, Medicare cuts as much as 3 percent for each patient, although the average is generally much lower. The patient safety penalties cost hospitals 1 percent of Medicare payments over the federal fiscal year, which runs from October through September.Feb 3, 2022

Why are readmission rates so high?

Failing to include patients in the discharge process results in higher hospital readmission rates, studies show. Patients who reported that they were not involved in their care during the original encounter were 34 percent more likely to experience a readmission, a recent Patient Experience study showed.Jan 8, 2018

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 is 30-day readmission rate?

The HRRP 30-day risk standardized unplanned readmission measures include: 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.Dec 1, 2021

When did the Hospital Readmissions Reduction Program start?

The Hospital Readmissions Reduction Program (HRRP) was created by the 2010 Affordable Care Act and began in October 2012 as an effort to make hospitals pay more attention to patients after they leave. Readmissions occurred with regularity — for instance, nearly a quarter of Medicare heart failure patients ended up back in the hospital within 30 days in 2008 — and policymakers wanted to counteract the financial incentives hospitals had in getting more business from these boomerang visits.

How many hospitals are exempt from Medicare?

An additional 2,216 hospitals are exempt from the program because they specialize in children, psychiatric patients or veterans. Rehabilitation and long-term care hospitals are also excluded from the program, as are critical access hospitals, which are treated differently because they are the only inpatient facility in an area. Of the 3,046 hospitals for which Medicare evaluated readmission rates, 82% received some penalty, nearly the same share as were punished last year.

Is Medicare cutting Medicare payments?

The federal government’s effort to penalize hospitals for excessive patient readmissions is ending its first decade with Medicare cutting payments to nearly half the nation’s hospitals.

How to reduce avoidable readmissions?

Reducing avoidable readmissions requires that hospitals build partnerships with other providers and the community to address social risk factors and promote continuous care when a patient is discharged from the hospital. Partnerships with community service providers can facilitate the transition of patients back into the community and ensure continuity of care for patients following hospitalization. Many hospitals already have relationships within their communities through community benefit activities associated with non-profit status. Hospitals may leverage and build on their community benefits activities and programs to address social determinants that lead to readmissions by connecting patients to community programs. For example, a referral to a community-based organization may ensure that a patient has transportation access for a follow-up visit post-discharge. This can be supported through informal or formal agreements with primary care providers and practices that promote data-sharing and cooperation. These are essential to maintaining the continuity of care. They will ensure that the next care provider is aware of the patient’s status and care information. Community partners can direct at-risk patients to needed care following hospitalization. Community partners can also address other non-medical factors that could lead to readmissions such as issues related to social support, health literacy, and food and housing security. In addition, hospitals may benefit from developing or strengthening their relationship with public health officials. These partnerships can increase access to local level data to inform readmission reduction efforts. In places where these partnerships already exist, hospitals could focus on strengthening them.

How does communication improve patient care?

Effective clinician-patient communication is directly linked to improved patient satisfaction, adherence, and health outcomes. 55 Communication is essential to the care process and to preventing avoidable readmissions. However, providers often have limited time to develop a personal connection with patients and ensure appropriate patient-provider communication during the inpatient stay. The goal of effective communication is patients’ ability to understand three things: (1) their diagnosis and its implications for care, (2) care choices, including what requires attention, and (3) discharge instructions, including what signs and symptoms trigger a return visit, when to return for a routine follow-up, and how to take the prescribed medications.36 Low health literacy, mistrust, or language barriers can influence a patient’s understanding.36,56-59 Patients from minority racial and ethnic backgrounds, as well as patients with disabilities, are often dissatisfied in their experiences with communicating with their clinicians.60,61

Which census division had the highest rate of readmission?

Census division: The South Atlantic Census Division had the highest representation in the study sample (21.9%); the Mountain Division represented the smallest geographic subgroup (5.3%). Medicare beneficiaries residing in the New England Census Division had the highest rate of 30- day readmission (15.5%), and those from the Mountain Division had the lowest (12.3%).

What is readmissions disparity?

In addition, populations made vulnerable through public policies, social inequity, and social bias are known to be at heightened risk for hospital readmissions, and this increased likelihood is known as a readmissions disparity. Understanding the drivers of readmissions disparities can help to improve health outcomes for Medicare beneficiaries, particularly for those who are vulnerable, and in containing readmissions-related costs.

What are the objectives of the 30-day readmission study?

Study Objectives and Research Questions This study sought to analyze whether demographic, clinical, and geographic characteristics were associated with 30-day hospital inpatient readmissions in Medicare fee-for-service (FFS) beneficiaries; specifically, whether key demographic, clinical, and geographic groups known to be disproportionately impacted by social risk factors had higher rates of 30-day hospital inpatient readmission. This report details the relationships identified between readmissions and race and ethnicity, potentially disabling condition status, Medicare-Medicaid dual eligibility status, and rurality, stratified by level of index hospital quality rating, primary diagnoses at index

What is the purpose of the readmission analysis?

The overarching purpose of the analysis was to identify disparities in readmissions across levels of the above indicators of interest (e.g. race and ethnicity groups), stratified by (1) discharge settings (e.g. home/self-care, skilled nursing facility, home health care, inpatient rehabilitation facility), (2) levels of hospital quality, (3) a select set of high-frequency diagnoses, and (4) Census divisions. A more nuanced understanding of such associations supports the CMS Office of Minority Health’s goal to achieve health equity across all Medicare beneficiaries.

How long does it take for a hospital to readmission?

CMS defines hospital readmissions as inpatient stays that occur within 30 days of discharge from the index admission (i.e. initial inpatient hospitalization) (CMS, 2018). Hospital readmissions are considered a core health care quality indicator due to the fact that they can be the direct result of substandard care during index hospitalization, poor discharge planning, and/or poor coordination of post-acute care services (Feigenbaum et al., 2012). While overall readmission rates have decreased over time, data from 2006–2015 suggest that there are consistent racial and ethnic- and geographic-related disparities in hospital readmissions (Desai et al., 2016; Martsolf et al., 2016). Additional research concerning hospital readmissions suggests that factors such as hospital size and type affect readmissions (Gerhardt et al., 2013; Martsolf et al., 2016). Moreover, lower- quality hospitals tend to have higher rates of readmission than do higher-quality hospitals (Krumholz et al., 2017).

What is RQ3 in hospitalization?

RQ3: Setting of discharge from index hospitalization

What are the other post acute care settings?

Other post-acute care settings included discharges to court/law enforcement, federal hospitals, and other types of health care institutions not specified elsewhere.

Medicare Blog