Apr. 23—Among the 3.3 million 30-day all-cause readmissions identified in a recent study, the most frequent in 2011 stemmed from congestive heart failure, septicemia, and pneumonia.

The analysis of federal hospital databases by the Agency for Healthcare Research and Quality found Medicare beneficiaries' health conditions drove readmissions and their $41.3 billion cost nationally.

Readmissions among Medicare patients linked to congestive heart failure totaled 134,500, while 92,900 were attributed to septicemia and 88,800 were tied to pneumonia.

The largest drivers of readmissions among patients with other types of insurance or no insurance were significantly smaller, such as the 41,600 Medicaid beneficiaries readmitted for "mood disorders."

Patients with Medicare comprised nearly 60 percent of total readmissions and accounted for slightly less—58 percent—of the associated costs; Medicaid patients accounted for the second-largest share—21 percent—of total readmissions and 18 percent of the associated costs; private insurance patients comprised 19 percent of readmissions and accounted for 20 percent of associated costs; and the uninsured accounted for only 5 percent of total readmissions and 4 percent of costs.

Readmission rates per 100 admissions ranged from 8.7 for the privately insured to 17.2 for Medicare beneficiaries, the study found.

Penalty Causes Included

The 10 most common causes for Medicare readmissions accounted for 39.1 percent of Medicare readmissions and included three conditions targeted by the Centers for Medicare & Medicaid Services (CMS) hospital readmissions reduction program: congestive heart failure, pneumonia, and acute myocardial infarction.

Also included in Medicare's top 10 readmissions causes were cardiac dysrhythmias, acute cerebrovascular disease, chronic obstructive pulmonary disease and bronchiectasis, urinary tract infections, acute and unspecified renal failure, and complication of a device, implant, or graft. The study did not include risk adjustments or account for readmissions that were planned, which Medicare estimates occur in about 12 percent of heart attack cases, 6 percent of heart failure cases, and 4 percent of pneumonia cases.

CMS will launch the third phase of the readmissions reduction program on Oct. 1, 2014, and raise the maximum penalty for the worst-performing hospitals to 3 percent of their total Medicare payments. That next phase of the program also will add chronic lung disease and elective hip and knee replacements to the conditions for which readmissions are penalized. 

Rich Daly is a senior writer/editor in HFMA's Washington, D.C., office. Follow Rich on Twitter @rdalyhealthcare.


Publication Date: Wednesday, April 23, 2014