Understanding the Top Contributors to Hospital Readmissions

Hospitalizations account for almost one-third of the total health care spending in the United States. A substantial portion of those hospitalizations are readmissions, which is why the Hospital Readmissions Reduction Program (HRRP) was created by CMS. HRRP requires CMS to reduce payments to IPPS hospitals with excess readmissions, effective for discharges beginning on October 1, 2012. In 2016 alone, CMS withheld more than $500 million in payments under its readmission reduction program. It’s clear that it has never been more important for providers to emphasize compliance to reduce readmissions.

To understand the best ways to prevent readmissions, it’s important to recognize the conditions that cause them in the first place. Below are the top five conditions that contribute most to hospital readmissions.

1. Health Conditions

A patient’s health condition plays a massive role in readmission rates. Congestive Heart Failure (CHF) has been named the top cause of readmissions among Medicare patients. Other conditions that tend to result in higher readmission rates include septicemia, pneumonia, COPD and cardiac dysrhythmias.

2. Insurance Type

Believe it or not, the type of health insurance that a person has been identified as a link to patient readmission risk. Medicare and Medicaid patients have the highest rates of readmission, compared to private health insurance patients, which only encompass a small portion of the numbers.

3. Patient Demographics

An analysis published in 2016 uncovered the relationship between race, gender, age, income, and hospital readmissions. For example, women who had been treated for heart attacks were found to have a greater likelihood of readmission within 30 days. Lower income communities are also more likely to be readmitted than higher income communities. Even a person’s personality type can impact the likelihood that they will adhere to prescribed health protocol after being discharged from the hospital.

4. Low Patient Engagement

Boston Medical Center researchers have found that patients who lack the knowledge, skills, and confidence to manage their own care after being discharged from the hospital have nearly double the rate of readmissions. These disengaged patients are perhaps the easiest to resolve in the bunch.

Several studies by the NIH have determined that relatively simple interventions can dramatically reduce the high hospital readmission rates for patients with COPD and other diseases with high readmission rates. For example, patient education, home visits, and follow-up phone calls have been shown to reduce hospital readmissions for exacerbations of COPD by nearly 40%. Clear communication, smooth transitional care, and an understanding of at-risk populations have all contributed to lowering readmission rates nationwide.

GoMo Health has tailored its Concierge Care^® solution to help reduce readmissions for the top causes and costs for hospitals and health plans. Concierge Care extends remote care management even further – customizing communications, resources and support for subscribers. By increasing patient engagement and customizing the support that different patients need, Concierge Care has proven to reduce hospital readmissions and overall cost of care.