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Trends in Hospital Readmissions: What the Newest Data Are Telling Us

Posted on November 30, 2015   |   
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The Healthcare Cost and Utilization Project (HCUP -- pronounced "H-CUP") is a partnership between 47 states, hospital associations, data organizations and the Federal government’s Agency for Healthcare Research and Quality. The consortium developed and maintains comprehensive healthcare data sets and associated tools, including the largest repository of encounter-level longitudinal hospital care data in the United States.

In November 2015, HCUP released a statistical brief outlining trends in hospital readmissions for the four highest-volume conditions: acute myocardial infarction (AMI), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and pneumonia. Data for the brief were extracted from two HCUP databases: the 2013 Nationwide Readmissions Database (NRD) and the 2009-2012 State Inpatient Databases (containing information about inpatient hospitalizations).

Here are a few takeaway findings, with a particular focus on COPD:

  • In 2013, COPD (including bronchiectasis) ranked sixth among index diagnoses with the highest readmission rates, following CHF, schizophrenia and other psychotic disorders, respiratory failure, diabetes and acute renal failure. The national average readmissions rate in 2013 was 13.9 percent; for COPD it was 20 percent, 44% higher than the national average.
  • COPD index diagnosis readmission rates decreased by 1.2 per 100 index stays – or 6 percent – from 2009 to 2013.
  • When readmission rates were analyzed by prospective payer, rates for COPD readmissions declined for Medicare (-1.7 percent), private payers (-1.1 percent) and the uninsured (-14.0 percent); however, Medicaid readmission increased (+1.7 percent). In comparison, rates for MI and CHF decreased across the board, independent of payer (rates of decrease from 4.1 percent to 18.3 percent). Note, however, that these were added to the list of included Hospital Readmissions Reduction Program (HRRP) conditions prior to the addition of COPD; therefore, concerted efforts to decrease these rates may have been implemented prior to those for COPD.
  • Data for all four HRRP conditions showed that in 2013, rates of all-cause readmissions paid under Medicare and Medicaid were more than 8 percentage points higher than for those privately insured or uninsured.
  • From 2009 to 2013, overall healthcare costs decreased for all conditions across all payers, most dramatically for those privately insured (22 percent). For COPD specifically, costs decreased most among the uninsured (down 22.9 percent) and those privately ensured (down 21.6 percent). The impact is still striking, however; readmissions for COPD as an index diagnosis cost $1.38 billion in 2013.

Overall, the data show that while we are headed in the right direction, the impact of COPD readmissions remains substantial. What are your thoughts on the report? What do you think accounts for the progress in overall COPD readmissions during this time frame – and what is next?

For more information about HCUP and their related tools, visit the HCUP website at https://www.hcup-us.ahrq.gov/overview.jsp.

The statistical brief can be found here: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb196-Readmissions-Trends-High-Volume-Conditions.jsp*

*The authors note that these calculations are different than those done for HRRP, which uses a different algorithm. In addition, while the direction and relative size of the differences across time points are comparable, the HCUP calculations differ from Kaiser Family Foundation calculations. The latter are determined through the use of Hospital Compare data.

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