Readmissions Benchmarks: Targeted Conditions and Identification Methods

Thursday, March 4th, 2010
This post was written by Melanie Matthews

Findings published in an April 2009 issue of the New England Journal of Medicine formalized what healthcare organizations have observed for a long time: that Medicare readmissions are frequent and costly. Given this data, it’s not surprising that more than 40 percent of respondents to the Healthcare Intelligence Network Reducing Hospital Readmissions survey are focusing much of the work to reduce readmissions on their Medicare population. However, organizations who have successfully reduced avoidable hospitalizations among the elderly say it’s not unusual for these pilot efforts to trickle down to all patients with high-risk factors, especially when the pilot programs get positive results.

“Because we saw the potency of this intervention, we expanded this across our entire book of business in 2009,” notes Mary Cooley, R.N., B.S.N., M.S., C.C.M., manager of case and disease management at Priority Health. During a recent HIN webinar, Cooley reported on Priority’s robust results on hospital readmission rate reductions for its MedicareAdvantageSM product line. On the heels of that success, Priority Health rolled out the program across its entire book of business — and is reporting success across all populations. “We focused first and foremost on our heart failure members, knowing that the literature tells us that many of those admissions are avoidable. We started in January 2009 promoting care transitions for anybody leaving the hospital with a primary diagnosis of heart failure, and shortly expanded that in March 2009 to all members on our heart failure registry who are inpatient for any reason.”

Readmission of patients with heart failure represents one of the most expensive and often preventable adverse outcomes. CMS research has shown that hospital readmissions are reducing the quality of healthcare while increasing hospital costs. CMS’s Hospital Compare data show that for patients admitted to a hospital for heart attack treatment, 19.9 percent of them will return to the hospital within 30 days, 24.5 percent of patients admitted for heart failure will return to the hospital within 30 days, and 18.2 percent of patients admitted for pneumonia will return to the hospital within 30 days.

According to the American Heart Association, an estimated 5.7 million Americans are living with heart failure, and 670,000 new cases are diagnosed each year. The condition is the number one cause for hospitalization among the elderly; one fifth of all hospitalizations have a primary or secondary diagnosis of heart failure.

Heart failure was overwhelmingly the number one condition at which respondents’ efforts to reduce hospital readmissions are directed, as reported by 77.6 percent of survey-takers. Nearly the same number of programs — 71.4 percent — are working to reduce readmissions among patients with COPD, closely followed by work in the area of CVD (67.3 percent). At the same time, nearly half of respondents are working to prevent avoidable hospitalizations among those patients with stroke (46.9 percent), pneumonia (44.9 percent) and heart attack (42.9 percent).

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