The unfortunate experience of having to return to the hospital after recently being treated is all too common. Potentially avoidable hospital readmissions that occur within 30 days of a patient’s initial discharge are estimated to account for more than $17 billion in Medicare expenditures annually.[1] Not only are readmissions costly, but they are often a sign of poor quality care. Many readmissions can be avoided through improvements in care, such as making sure that patients leave the hospital with appropriate medications, instructions for follow-up care and follow-up appointments scheduled to make sure their recovery stays on track.
To address the problem of avoidable readmissions, several initiatives has been implemented. The Affordable Care Act created the Hospital Readmissions Reduction Program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions, such as heart attacks, heart failure and pneumonia. Other major quality improvement initiatives, such as the Partnership for Patients, were established which aim to make hospital care safer and improve the quality of care for individuals as they move from one healthcare setting to another. Quality Innovation Networks, such as Great Plains Quality Innovation Network, are also funded to reduce hospital readmissions through improved care coordination efforts.
The data show that these efforts are working. As described below, between 2010 and 2015, readmission rates fell by 8 percent nationally. CMS is releasing data showing how these improvements are helping Medicare patients across all 50 states and the District of Columbia. The data show that since 2010:
- All states but one have seen Medicare 30-day readmission rates fall [2]
- In 43 states, readmission rates fell by more than 5 percent. Three of the four Great Plains QIN states (Kansas, Nebraska and North Dakota) fall into this category
- In 11 states, readmission rates fell by more than 10 percent (South Dakota’s readmissions rate decreased by 11.4 percent)
Across the country, Medicare beneficiaries avoided approximately 100,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels. That means Medicare beneficiaries collectively avoided nearly 100,000 unnecessary return trips to the hospital. Cumulatively since 2010, the HHS Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions.
Improving care coordination leads to better patient outcomes, overall satisfaction and reduces avoidable hospital admissions. Great Plains QIN is partnering with healthcare professionals throughout the region to unite stakeholders, consumers and the provider community to improve communication and care coordination – resulting in reduced hospital admissions, readmissions and medication harm.
For more information on our efforts and to join our large community of committed providers, join our Learning and Action Network. Learn more!
To preview the CMS news story, including the data 2010 and 2015 readmission data, visit the CMS blog.
[1] Jencks, S. F., Williams, M. V. and Coleman, E. A. (2009). ‘Rehospitalizations among patients in the Medicare fee-for-service program’. New England Journal of Medicine, 360 (14), 1418-1428.[2] The readmission rate in Vermont was virtually unchanged, increasing slightly from 15.3% in 2010 to 15.4% in 2015. This change correlates to 21 additional readmissions compared to if the state’s rate had remained constant.