Issue link: https://emsworld.epubxp.com/i/336320
Introduction Healthcare reform has pin- pointed hospital readmissions as a key area for improving care coordination and achieving potential savings. Identifying conditions that contribute the most to the total number of readmissions and related costs for all payers may aid health- care stakeholders in deciding which conditions to target to maximize quality improvement and cost-reduction efforts. This Statistical Brief uses readmis- sions data from the Healthcare Cost and Utilization Project (HCUP) to present the condi- tions with the largest number of 30-day all-cause readmissions among U.S. hospitals in 2011 and their associated costs. Findings In 2011, there were approxi- mately 3.3 million readmissions in the United States across all payers in the study population. Readmissions contributed $41.3 billion in total hospital costs. Medicare patients—Three conditions currently targeted by the CMS Hospital Readmissions Reduction Program rank among the top 10 conditions identified here. These include congestive heart failure, pneumonia and acute myocardial infarction. Medicaid patients—Four mental health or substance use disorders were among the conditions resulting in the most all-cause, 30-day readmissions for Medicaid patients. These conditions included mood disorders, schizophrenia and other psychotic disorders, alcohol-related disorders, and substance-related disorders. Privately insured patients— Maintenance chemotherapy accounted for the largest share of readmissions (4.2%) among privately insured patients; however, it should be noted that these were most likely planned readmis- sions for cancer treatment. Uninsured patients—Four conditions related to mental health or substance use disorders resulted in 28,400 readmis- sions and $165 million in costs: mood disorders, alcohol-related disorders, schizophrenia and other psychotic disorders, and substance-related disorders. 26 Integrated Healthcare Delivery July 2014 www.ihdelivery.com 26 Journal Watch By Staff Conditions Causing Readmissions CONDITIONS CAUSING THE MOST READMISSIONS Hines AL, Barrett ML, Jiang HJ, Steiner CA. Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011. Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Statistical Brief #172, www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.pdf. Medicare patients Medicaid patients Private-insured patients Uninsured patients CHF (nonhypertensive) Mood disorders Maint. chemo/radiotherapy Mood disorders Septicemia (exc. in labor) Schizo./psych disorders Mood disorders Alcohol-related disorders Pneumonia Diabetes mellitus w/compl. Care/surgery complications Diabetes mellitus w/compl. COPD/bronchiectasis Other pregnancy complic. Complication of device, etc. Pancr. disorders (not diab.) Cardiac dysrhythmias Alcohol-related disorders Septicemia (exc. in labor) Skin/SQ tissue infections Urinary tract infections Early/threatened labor Diabetes mellitus w/compl. Nonspecifc chest pain Acute/unspec. renal failure CHF (nonhypertensive) Secondary malignancies Schizo./psych disorders AMI Septicemia (exc. in labor) Early/threatened labor CHF (nonhypertensive) Complication of device, etc. COPD/bronchiectasis Pancreatic disorders (not diabetes) Substance-related disorders Acute cerebrovasc. disease Substance-related disorders Coronary atherosclerosis/heart dis. AMI Table 1: Conditions With the Most All-Cause 30-Day Readmissions, 2011 IHD_26-28_JournalWatch.indd 26 6/13/14 11:26 AM