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From Health Law Daily, May 30, 2013

Hospital readmission rates take a big dip in 2012

By Jenny M. Burke, JD, MS

Hospital readmission rates among fee-for-service (FFS) Medicare beneficiaries declined significantly in 2012, the Medicare and Medicaid Research Review reports, after studying readmission data since 2007. Medicare FFS beneficiaries experiencing at least one acute inpatient hospital stay were analyzed, and the percentage of them who were re-hospitalized within 30 days of being discharged from an inpatient stay fell from an average of 19 percent between 2007 and 2011, and then to 18.4 percent in 2012. Although the study found that the drop in rates from 2011 to 2012 was statistically significant and not driven by an influx of younger, healthier beneficiaries, the underlying causes of the decline are not yet clear.

Program goals. It has long been a goal to cut down on hospital readmissions, as they are costly and are a common metric for assessing quality of care. Over the last several years, CMS has led several initiatives in hope of reducing these readmissions among the Medicare fee-for-service (FFS) population. Reporting hospital readmission rates through Hospital Compare, funding hospital-level improvements through the Partnership for Patients program, changing payment policies through the Hospital Readmissions Reduction Program, and various shared savings initiatives have all been part of CMS’ plan to reduce readmissions.

Study population. As a base for this study, the Medicare and Medicaid Research Review report used claims data from the Chronic Condition Data Warehouse, which contains all Medicare claims for beneficiaries who are enrolled in the FFS program. Therefore, the study population is all Medicare beneficiaries enrolled in Part A, including those under the age of 65, who were not enrolled in Medicare Advantage.

Drop in admissions and readmissions. During 2012, the study found that the monthly readmission rate dropped to a low of 18 percent in October and averaged 18.4 percent for the year, which was more than half a percentage point lower than the average rate from 2007 to 2012. The study indicates that this reduction translates to approximately 70,000 fewer readmissions during 2012 than if the rate had remained at 19 percent.

Geographical readmission data. A significant degree of variation was found in the unadjusted readmission rates in different areas of the country. The readmission rates were highest in the mid-Atlantic region, the eastern Midwest, and certain areas in the South and on the West Coast. The largest reduction in readmission rates was in Longview, Texas, while the largest increase was in Bloomington, Illinois.

Factors for change. Not only were readmission rates lower in 2012, but the absolute number of index admissions and readmissions per beneficiary has been dropping over the six-year period analyzed, according to the study. There are many possible reason for the drop. One possible explanation for the observed reduction in rates in 2012, the study points to, is that payment reforms and other initiatives aimed at reducing avoidable readmissions are starting to have a measurable impact on provider behavior and are resulting in improved care. Also, more beneficiaries are receiving post-discharge care through emergency departments, observational stays, or other non-inpatient settings without material improvements in quality of care, also slowing the need for readmission.

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