Readmissions Reduction

As healthcare costs consume more and more of American resources, driven in large measure by the growing burden of chronic disease, both policy proposals and demonstration projects are exploring ways to improve care and to reduce costs. In many of these efforts, hospital readmission rates have become an important measure of both quality and costs. Not only are readmission rates extraordinarily high (17.6% of Medicare beneficiaries are readmitted within 30 days of discharge, resulting in $15 billion in spending annually1), but between 10% and 50% of readmissions are considered to be potentially avoidable.2 Lastly, 30-day readmission rates have become important hospital financial metrics, as payors — most notably Medicare — are increasingly denying coverage without detailed medical justification for the readmission.

Using a readmission rate as a quality or cost measure, however, is not without shortcomings. There are numerous questions, for example, about the positive and negative impact on provider behavior of rewarding, penalizing and/or publishing readmission rates. The need for more information about the nature and characteristic of hospital readmissions is clear. PRHI's work with readmissions aims to add clarity to the debate by developing a series of reports that focus on the following questions:

  1. What is the “right” time frame for defining a potentially avoidable readmission? For how many days past discharge is a readmission potentially preventable, and how does this vary by condition?
  2. To what extent are readmissions likely to be related to an initial admission and to what extent does this vary across diagnoses?
  3. To what extent are readmissions within the domain of hospital control?
  4. Are there patterns of admissions and readmissions that can help clinicians flag, and then prevent, unnecessary hospitalizations?

Follow this link to our Publications page to review the four Readmissions Briefs PRHI has published.

Read more about how we are working to reduce readmissions with our Accountable Care Network project.

Key Contact

Keith T. Kanel, MD, MHCM, FACP
Chief Medical Officer
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1 MedPac Report to Congress, “Promoting Greater Efficiency in Medicare, Chapter 5: Payment Policy for Inpatient Readmissions”, June 2007, http://www.medpac.gov/chapters/jun07_ch05.pdf
2 Jencks, SF, “Rehospitalization: The Challenge and the Opportunity for CVEs,” Presentation 29 October 2009.