Costs associated with readmissions in Belgian acute-care hospitals

Abstract

Introduction: Internationally, hospital readmissions have a great appeal as an indicator of hospital quality. Since possibilities in prevention and control exist, reducing rates of hospital readmission has attracted attention of policymakers as a way to improve quality of care while simultaneously reducing costs. Therefore reducing the number of readmissions is considered to be a pillar of more cost-effective hospital care. The goal of this study was to estimate the cost of hospital readmissions at a national level, describe differences in readmission rates between hospitals and to calculate the potential monetary savings of reducing excess readmissions.

Methods: Stays data were obtained from the Minimum Basic Data Set 2008 in a sample of 45 hospitals representing 16,141 beds. Readmissions were identified as a second admission for the same patient with the same APR-DRG code within 1 month or 3 months after discharge. Hospital type, diagnosis-related group, age and gender were used as matching factors in comparing readmission rates. Specific types of readmissions that occur naturally in each other's proximity due to the repeating nature of the therapy were excluded from the analysis. The costs per readmission were then calculated by linking the stays data with the cost data per APR-DRG and per severity index using the 2008 national feedback. The results of our sample were then extrapolated to all Belgian hospitals in order to calculate the total cost of readmissions. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of readmissions in hospitals having a higher readmission rate in comparison to other hospitals would be realized.

Results: In our sample 1.5% readmissions within 1 month after discharge and 2.1% within 3 months after discharge were identified. The additional weighted mean cost of these readmissions was Euro 3,495.58 within 1 month and Euro 3,572.20 within 3 months. The total financial burden, as extrapolated to the Belgian setting, is estimated at Euro 280,091,471.The wide variability between hospitals in incidence of readmissions (1.17-6.40%) indicates a potential for improvement. For instance, if all Belgian hospitals having a higher readmission rate improve their rate to the level of the hospital corresponding to percentile 75 (= 2.4% readmissions) savings would amount to Euro 14,118,509.

Conclusion: The observed incidence of readmissions is associated with important additional healthcare costs. Although not all readmissions can be prevented, there is clearly a potential to increase cost-effectiveness of hosp tal care delivery.