Statistics on Medicare Re-Hospitalizations and Readmissions Penalties

Did you that nearly one out of every five Medicare patients returns to the hospital within one month of discharge?

Did you that nearly one out of every five Medicare patients returns to the hospital within one month of discharge?

Hospitalizations are a source of mega-spending in healthcare, mounting to one-third of the total $2 trillion health costs. However, return visits within 30 days, or re-hospitalizations, account for one in nine hospital admissions. The total cost for these repeat hospital stays is estimated to be $30.8 billion, which accounts for $1 out of every $10 spent on US hospital care. Despite previous efforts, the national readmission rate hovers around 19%.

For the elderly, re-hospitalizations can be traumatizing and are often avoidable. Research shows that 75 percent, or 4.4 million, Medicare hospital readmissions may be preventable, a potential savings of up 17 billion in of annual Medicare spending. 

Why are Medicare patients returning to the hospital?

According to The Agency for Healthcare Research and Quality (AHRQ), 90% of readmissions within 30 days are unplanned and likely the result of a break in the clinical process. Poor care coordination and continuity may be to blame – only half of re-hospitalized patients see a physician prior to readmission. Studies also show nearly 20% of Medicare discharges are followed by an adverse event within 30 days and is related to medication two-thirds of the time.   

Until now, hospitals have had little incentive to keep patients at home and out of the hospital. That all changed in the Fall of 2012 when the Centers for Medicaid and Medicare (CMS) began issuing penalties against over 2,000 US hospitals with the highest readmission rates. Hospitals that serve vulnerable populations and low-income patients will be hit the hardest by penalties. Kaiser Health News reports Institutions in New York, New Jersey, Washington DC, Massachusetts, Illinois, Arkansas, Kentucky, and Mississippi stand to lose the most.

How does Medicare define a “readmission”?

According to Medicare.gov, the 30-day readmission measure, “estimates…readmission for any cause to any acute care hospital within 30 days of discharge. These measures include patients who were initially hospitalized with one of several primary diagnoses (heart attack, heart failure, and pneumonia), regardless of whether patients are readmitted to the same or to a different hospital.” The measure includes patients discharged to a nursing home setting.  

For more information on Medicare readmissions and avoidable hospitalizations see these resources from Kaiser Health:

• Readmissions Penalties By Hospital (PDF file)
• Download Data For All Hospitals (CSV file)