Hospital readmission rates are receiving increasing attention by Medicare, Medicaid, and private health plans.  Research shows that a high proportion of hospital readmissions are preventable.  Most hospital payment methods, most notably the Medicare Part A inpatient prospective payment system (IPPS), create strong financial incentives for hospitals to discharge patients quickly.

Therefore, Medicare and other payors are looking at ways to reform hospital reimbursement to create incentives to reduce readmissions, improve quality, and reduce medical errors and healthcare-acquired conditions.  In the world of Medicare, these efforts include an array of policies mandated under the Affordable Care Act (ACA), notably: Medicare Shared Savings Program and Accountable Care Organizations (ACOs), hospital value-based purchasing, demonstration of bundled payment, the Partnership for Patients, and payment adjustments related to hospital-acquired conditions, other preventable events, and hospitals with especially high readmission rates.  Many similar efforts are being adopted by State Medicaid programs.  Meanwhile, health plans have implemented many innovations to prevent hospital admissions and readmissions.

Fascinating new data from the HHS Agency for Health Care Research and Quality (AHRQ) shows hospital readmission rates, by age and payor.  The data show particularly high readmission rates for disabled Medicare patients and pregnant women in Medicaid.

Highlights on Hospital Readmissions:

  • 30-day readmission rates are about 25 percent higher among disabled, non-elderly Medicare patients (24.1 percent) than among Medicare patients 65 and over (19.0 percent).
  • Among non-maternal adults ages 45–64 years old, Medicaid patients are re-hospitalized about 60 percent more often than uninsured patients and about twice as frequently as privately insured patients, regardless of the readmission period (30-day, 14-day, and 7-day).
  • Maternal readmission rates are about 50 percent higher for uninsured and Medicaid patients than for privately insured patients across all time periods.
  • Medicaid and privately insured pediatric patients are re-hospitalized within 7 and 14 days at a similar rate and more frequently than uninsured patients irrespective of the readmission period.
  • Across all payers and age groups, readmission rates increase with the number of days post-discharge.  The 30-day readmission rate is higher than the 14-day rate, which is higher than the 7-day rate.

Medicare Hospital Readmissions by Age:

Hospital readmission rates are 25% higher for disabled Medicare beneficiaries than for seniors.

Although disabled, non-elderly patients (18 to 64 years) comprise a relatively small proportion of stays billed to Medicare (17.8 percent), their readmission rates are much higher than those for elderly patients (65 years and older).

For example, 30-day readmission rates are about 25 percent higher among non-elderly than among elderly Medicare patients (24.1 percent versus 19.0 percent).

In contrast, hospital readmission rates for non-maternal stays increase with age for Medicaid, privately insured, and uninsured patients.

Hospital Readmission Rates for Adults by Payor:

Among adults aged 45–64 years old, Medicaid patients are re-hospitalized about 60 percent more often than uninsured patients and about twice as frequently as privately insured patients, regardless of the readmission period.

For example, the non-maternal 30-day readmission rate is 24.4 percent for Medicaid patients compared with 14.4 percent for the uninsured and 11.9 percent for the privately insured.

Hospital Readmission Rates for Children By Payor:

For hospital care, the vast majority of children are insured by either Medicaid (54 percent) or private health insurance (42 percent).  Only about 4 percent of hospital stays by children are uninsured.

Medicaid and privately insured pediatric patients are re-hospitalized within 7 and 14 days at a similar rate and more frequently than uninsured patients irrespective of the readmission period.

For example, the 30-day readmission rate is 12.1 percent for Medicaid patients and 11.3 percent for privately insured patients.  This compares with 7.0 percent for uninsured children.

These figures are for non-maternal stays by children and adolescents.

Hospital Readmissions by Pregnant Women

For hospital readmissions, nearly half (45.0 percent) of Medicaid patients are classified as maternal.  Obstetric patients accounted for 28.1 percent of privately insured and 7.6 percent of uninsured patients.

Maternal readmission rates are about 50 percent higher for uninsured and Medicaid patients than for privately insured patients across all time periods.

Across all payers, hospital readmissions for maternal discharges are less frequent than for non-maternal discharges.

For purposes of tracking admissions and readmissions, a patient is classified as maternal if they had at least one inpatient stay related to pregnancy, childbirth, and post-partum conditions in the year.

The above figures are for 2008.  Analysis is from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP).

Learn More:

To learn more about hospital readmissions, read AHRQ’s June 2011 statistical brief on All-Cause Readmissions by Payer and Age, 2008.

For more data on hospital care costs and utilization, check out AHRQ’s statistics on Hospital-Based Care in the United States.

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