Risk Adjusted Readmission Rates Have Fallen in Virginia

To encourage efforts to reduce readmissions, Congress created within the Affordable Care Act (ACA) the Hospital Readmissions Reduction Program (HRRP), which instructs the U.S. Centers for Medicare & Medicaid Services (CMS) to penalize hospitals with higher-than-expected readmissions for specific clinical conditions such as heart attack, pneumonia, and heart failure. Nationally, hospitals are making significant progress. CMS reported that the national Medicare readmission rate fell to 17.5 percent in 2013 after holding steady around 19-19.5 percent for many years.1 So, is Virginia keeping up with the rest of the nation? We examined historical data for heart attack (AMI), pneumonia (PN) and health failure (HF). The three-year timeframe (since 2013) shows a decrease in RSRR across all conditions in Virginia. This trend includes all payers and age ranges, while the CMS national rate focuses on Medicare only. The most pronounced decrease is in heart failure, where rates have averaged roughly 17 percent for the past seven quarters. Readmission rates for all conditions, however, are rising again. Yet to date, they have not risen to previous former levels. So, what can clinicians take from these findings? First, it is likely the issues that were easy to address which prompted patients to return to the hospital have been resolved. These can be simple issues such as timely visits with community medical providers, or better education of patients and their families about medication regimens. Without continued diligence, these issues could make a comeback. The other possibility is that the current population returning to the hospitals has greater barriers to accessing necessary post-hospital care in their communities. Recent review of readmissions seems to indicate this could be an issue in need of additional attention. Health care providers should evaluate both possibilities in pursuit of provoking another downward trend in readmissions. (4/15)

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1U.S. Department of Health and Human Services. (May 7, 2014). New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings.