Conditions With the Largest Number of Adult Hospital Readmissions by Payer, 2011

Excerpt

Health care reform has pinpointed hospital readmissions as a key area for improving care coordination and achieving potential savings. Stakeholders are using data to devise strategies to reduce readmissions. Two criteria for evaluating potential areas of impact include volume and costs. For example, the Centers for Medicare & Medicaid Services (CMS) Hospital Readmissions Reduction Program has selected acute myocardial infarction, heart failure, and pneumonia as target areas for the Medicare population. CMS chose these conditions, in part, because of their high prevalence and their associated high costs for total admissions and readmissions among Medicare beneficiaries. In 2015, CMS will expand their assessment of readmissions to additional conditions that represent high volume and costs.

Identifying conditions that contribute the most to the total number of readmissions and related costs for all payers may aid health care stakeholders in deciding which conditions to target to maximize quality improvement and cost-reduction efforts. This Statistical Brief uses readmissions data from the Healthcare Cost and Utilization Project (HCUP) to present the conditions with the largest number of 30-day all-cause readmissions among U.S. hospitals in 2011 and their associated costs. We limited the study population to Medicare beneficiaries aged 65 years and older and to individuals aged 18–64 years who were privately insured, uninsured, or covered by Medicaid. We display the 10 conditions with the largest number of readmissions for each payer.