By: Lisa Remington, President, Remington Health Strategy Group, and Publisher, The Remington Report
Four years after the Hospital Readmission Reduction Program (HRRP) to reduce preventable readmissions was put into effect, the industry still grapples with the best solutions and practices for avoidable readmissions.
Trends from 2009-2013 for readmissions following an admission for four high-volume conditions AMI, CHF, COPD and pneumonia were the first conditions targeted by HRRP. These conditions were targeted because of their high-prevalence and their associated high costs for total admissions and readmissions among Medicare beneficiaries. In 2011, readmissions contributed $41.3 billion in total hospital costs. What can we learn about these readmissions? What can we do better to reduce readmissions?
What We Know About Readmissions:
• In 2013, there were about 500,000 readmissions totaling $7 billion in aggregate hospital costs for four high—volume conditions—acute myocardial infarction (AMI), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and pneumonia.
• Among initial hospital stays (index stays) for AMI, CHF, COPD, and pneumonia, the aggregate cost of readmissions in 2013 was $5.2 billion for Medicare—74 percent of the aggregate cost of readmissions for these four conditions.
• From 2009 to 2013, the readmission rate for stays covered by Medicare decreased by 13 percent for AMI, by 7 percent each for CHF and COPD, and by 6 percent for pneumonia.
• Overall, the largest decrease in readmission rate from 2009 to 2013 was for AMI (by 13 percent, from 16.9 to 14.7 readmissions per 100 index stays for AMI). Although the rate declined overall (across payers), the aggregate cost of readmissions following an index stay for AMI decreased only among index stays covered by private insurance (by 18 percent).
• Although Medicare was the only payer for which the rate of readmission for pneumonia decreased from 2009 to 2013, the aggregate cost of readmissions for pneumonia decreased for all payers, by 6-26 percent.
• The aggregate cost of readmissions following an index stay for any of the four conditions decreased from 2009 to 2013 for all payers, except the uninsured whose rate remain unchanged. The largest declines were for index stays paid by private insurance (22 percent) and Medicare (9 percent).