CMS blog – readmissions to hospitals

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.

medicare-30-day-readminssion-rate

 

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

 

 

[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.