Hospital readmissions: national and statewide trends and their impact on healthcare costs

Hospital readmissions have come under scrutiny in recent years due to the Patient Protection and Affordable Care Act (ACA) and are currently being used as both an indicator of the quality of care a patient receives and as a way to reduce healthcare costs. While readmissions are not always preventable and indeed are often pre-planned, they can result from a wide variety of factors linked to the quality of care the patient receives during their initial hospitalization. Studying hospital readmissions may be of significant interest to public health as this as a key component for improving the quality of healthcare as it is anticipated that not only will repeat patient hospitalizations be minimized, but so, too, will the associated costs. Using the Centers of Medicare and Medicaid’s (CMS) publicly published data files for 2011 through 2016 for the Hospital Readmission Reduction Program (HRRP), the number of hospitals penalized and the percentage penalized for acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), chronic obstructive pulmonary disease (COPD), and total elective knee and hip arthroplasty (TKA/THA) diagnoses were calculated. To compare national trends, the average percent penalty was calculated for each State and the District of Columbia, with the exception of Maryland. In addition, Pennsylvania was further examined using the Pennsylvania Health Care Cost Containment Council (PHC4). This data is publicly available for readmission measures abnormal heartbeat (AH), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and diabetes medical management (DMM). The percentage of hospitals penalized has increased each year since the HRRP was implemented. However, the percentage of hospitals penalized with the maximum penalty for the initial three measures (AMI, HF, and PN) has decreased from 2013 to 2014 and remained constant at 1.1% when COPD and TKA/THA diagnoses were added in 2015 and 2016. In Pennsylvania, readmissions have a significant impact on healthcare costs and patient outcomes for any reason ranging from 12.6% to 22.3% for the conditions examined in 2013 to 2014. These readmissions alone accounted for 7,673 additional days for AH, 19,340 additional days for COPD, 26,054 additional days for CHF, and 7,854 additional days for DMM at a cost of $84 million