Large Numbers of Hospitals Have High Readmission Rates

Up to 20 percent of hospitals in Illinois, Michigan, Maryland, Massachusetts, New Jersey, New York, and Rhode Island have higher rates of patients being readmitted than the national average, according to a report by the Kaiser Health News. These readmission rates are for all patients who are diagnosed with any condition, admitted to a hospital as an inpatient, and readmitted within a month for an unplanned reason. Hospitals in Colorado, Hawaii, Idaho, North Carolina, Oregon, South Carolina, Utah, and Washington had the lowest percentage of hospitals with readmission rates above the national average.

All Diagnosis Measure

CMS began using the readmission rate for all diagnosis in December 2013. Prior to that time Kaiser reports that only three aliments were used to measure readmission rates. The Medicare Payment Advisory Commission (MedPAC) has advocated the use of the all diagnosis measure when determining financial penalties for hospitals in the Hospital Readmission Reduction Program. Medicare began reporting on the readmission rate for patients who had a diagnosis of heart failure, heart attack or pneumonia in 2008.

Using only these three diagnoses for determining the readmission rate for a hospital may not be sufficient as many hospitals do not treat a large number of cases of heart failure, heart attack or pneumonia. Half of hospitals in the United States report treating 70 patients or fewer for heart attack over a three year period, MedPAC reported. Using the all diagnosis metric provides a substantially larger number of cases to measure readmission rates. MedPAC estimated that nine out 10 hospitals would have at least 1,100 cases of any kind during a three year period that could be used to measure readmission rates when the all diagnosis metric is used.

Reimbursement Reductions

During fiscal year (FY) 2014, 2,225 hospitals will have their reimbursement reduced by Medicare for excessive readmission rates for heart failure, heart attack and pneumonia, according to a Kaiser Health News report from August of 2013. Reductions in FY 2014 could have been as high as 2 percent, but only 18 hospitals will have their reimbursements reduced the full amount, Kaiser reported. The great majority of hospitals with reductions, 2,053 of them, will have their reimbursements reduced by less than 1 percent. In FY 2015 reimbursements can be reduced by as much as 3 percent for hospitals with high readmission rates. In FY 2014 these hospitals will lose $280 million in reimbursements.

Geographic Trends

At 364 hospitals patients were readmiited more frequently than the national average, Kaiser reported. Some of these hospitals are well known, such as the Cleveland Clinic and Duke University hospital. Chicago had 19 hospitals with readmission rates that were higher than the national average, and New York had 18 hospitals with readmission rates above the national average. Some hospitals have complained that hospitals that serve a large portion of low-income patients have a higher readmission rate for a variety of reasons.

Across the country 315 hospitals had readmission rates that were lower than the national average, including Baylor University Medical Center in Dallas, California Pacific Medical Center in San Francisco and Intermountain Medical Center in Murray, Utah. Oklahoma City had the most hospitals with lower than average readmission rates.