Potentially avoidable hospital readmissions

CMS Blog
http://blog.cms.gov/2016/09/13/new-data-49-states-plus-dc-reduce-avoidable-hospital-readmissions

 

September 7, 2016

By Patrick Conway, M.D., principal deputy administrator and chief medical officer, CMS; and Tim Gronniger, deputy chief of staff, CMS

The unfortunate experience of having to return to the hospital after recently being treated—or watching the same thing happen to a friend or family member—is all too common. Potentially avoidable hospital readmissions that occur within 30 days of a patient’s initial discharge are estimated to account for more than $17 billion in Medicare expenditures annually.[1]  Not only are readmissions costly, but they are often a sign of poor quality care. Many readmissions can be avoided through improvements in care, such as making sure that patients leave the hospital with appropriate medications, instructions for follow-up care, and follow-up appointments scheduled to make sure their recovery stays on track.

 

To address the problem of avoidable readmissions, the Affordable Care Act created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions such as heart attacks, heart failure, and pneumonia. The Centers for Medicare & Medicaid Services has also undertaken other major quality improvement initiatives, such as the Partnership for Patients, which aim to make hospital care safer and improve the quality of care for individuals as they move from one health care setting to another.

 

The data show that these efforts are working. As described below, between 2010 and 2015, readmission rates fell by 8 percent nationally. Today, CMS is releasing new data showing how these improvements are helping Medicare patients across all 50 states and the District of Columbia. The data show that since 2010: 

·         All states but one have seen Medicare 30-day readmission rates fall.[2]

·         In 43 states, readmission rates fell by more than 5 percent.

·         In 11 states, readmission rates fell by more than 10 percent.

 

 

 

Across states, Medicare beneficiaries avoided almost 104,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels. That means Medicare beneficiaries collectively avoided 104,000 unnecessary return trips to the hospital. Cumulatively since 2010, the HHS Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions.

 

The Hospital Readmissions Reduction Program is just one part of the Administration’s broader strategy to reform the health care system by  paying providers for what works, unlocking health care data, and finding new ways to coordinate and integrate care to improve quality. Other initiatives include Accountable Care Organizations, as well as efforts by Quality Improvement Organizations and Hospital Engagement Networks, which fund quality improvement expert consultants to work with provider and hospital communities to improve care. The goal of all of these efforts is to spend our health care dollars more wisely to promote better care for Medicare beneficiaries and other Americans across the country.

State	2010		2015		% Change in Readmission Rates	Reduction in readmissions in 2015 compared to 2010
	Hospital Admissions	Readmission Rate	Hospital Admissions	Readmission Rate
AK	9,809	14.50%	9,954	13.70%	-5.50%	-78
AL	154,856	17.20%	143,210	16.20%	-5.80%	-1,503
AR	103,056	17.70%	92,562	16.60%	-6.20%	-993
AZ	135,293	16.60%	128,061	14.80%	-10.80%	-2,270
CA	574,176	17.60%	547,558	16.60%	-5.70%	-5,580
CO	83,346	14.20%	81,822	12.90%	-9.20%	-1,099
CT	109,888	18.10%	96,492	16.70%	-7.70%	-1,306
DC	23,907	20.00%	23,194	18.50%	-7.50%	-346
DE	29,827	17.40%	32,257	15.60%	-10.30%	-575
FL	619,368	18.20%	588,187	17.70%	-2.70%	-3,161
GA	209,500	17.50%	191,485	16.20%	-7.40%	-2,453
HI	16,824	14.90%	15,799	12.90%	-13.40%	-315
IA	100,490	15.50%	91,256	14.50%	-6.50%	-910
ID	25,432	12.50%	28,139	12.20%	-2.40%	-78
IL	421,395	19.80%	335,610	17.40%	-12.10%	-8,108
IN	210,919	17.40%	186,241	16.10%	-7.50%	-2,474
KS	90,545	16.30%	87,224	14.70%	-9.80%	-1,361
KY	162,249	19.70%	132,511	17.90%	-9.10%	-2,384
LA	129,123	18.70%	112,328	16.90%	-9.60%	-2,013
MA	208,356	19.00%	197,649	17.90%	-5.80%	-2,213
MD	189,323	21.10%	170,510	18.90%	-10.40%	-3,789
ME	43,450	16.10%	38,571	15.50%	-3.70%	-232
MI	343,346	18.60%	280,152	18.00%	-3.20%	-1,767
MN	129,642	15.70%	130,725	14.60%	-7.00%	-1,435
MO	203,685	18.20%	174,677	16.90%	-7.10%	-2,311
MS	106,281	19.10%	96,252	17.60%	-7.90%	-1,469
MT	27,962	13.90%	27,518	13.10%	-5.80%	-231
NC	269,108	17.00%	235,283	15.90%	-6.50%	-2,472
ND	26,562	15.40%	26,650	14.40%	-6.50%	-267
NE	60,007	15.70%	56,791	14.40%	-8.30%	-735
NH	36,189	15.70%	39,871	15.30%	-2.50%	-152
NJ	281,282	20.30%	250,924	17.60%	-13.30%	-6,774
NM	36,209	15.20%	33,016	14.80%	-2.60%	-118
NV	51,787	18.00%	52,308	17.00%	-5.60%	-529
NY	491,897	19.90%	402,439	17.80%	-10.60%	-8,407
OH	325,091	18.80%	267,743	16.80%	-10.60%	-5,405
OK	119,346	17.40%	106,073	15.60%	-10.30%	-1,878
OR	58,182	14.30%	61,393	14.20%	-0.70%	-75
PA	369,418	18.10%	324,166	16.60%	-8.30%	-4,995
RI	24,142	19.00%	24,705	17.00%	-10.50%	-487
SC	130,950	16.50%	125,993	15.50%	-6.10%	-1,237
SD	31,269	14.90%	30,806	13.20%	-11.40%	-515
TN	207,875	18.40%	180,666	16.80%	-8.70%	-2,905
TX	571,147	17.10%	509,738	16.10%	-5.80%	-4,960
UT	33,534	12.20%	38,142	11.50%	-5.70%	-261
VA	207,241	17.50%	211,674	16.40%	-6.30%	-2,302
VT	15,439	15.30%	16,332	15.40%	0.70%	21
WA	130,798	15.30%	131,817	14.20%	-7.20%	-1,388
WI	137,336	15.60%	124,274	14.50%	-7.10%	-1,373
WV	70,144	19.90%	60,630	18.60%	-6.50%	-777
WY	13,277	15.10%	12,838	14.20%	-6.00%	-110

 

 

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[1] Jencks, S. F., Williams, M. V. and Coleman, E. A. (2009). 'Rehospitalizations among patients in the Medicare fee-for-service program'. New England Journal of Medicine, 360 (14), 1418-1428.

[2] The readmission rate in Vermont was virtually unchanged, increasing slightly from 15.3% in 2010 to 15.4% in 2015. This change correlates to 21 additional readmissions compared to if the state’s rate had remained constant.