All-payer data finds mixed results on readmissions in Massachusetts

Massachusetts' efforts to reduce unplanned hospital readmissions yielded mixed results in recent years, with a small portion of the patient population continuing to account for most readmissions, according to a new report from the state Center for Health Information and Analysis (CHIA).

CHIA's data, collected from acute hospitals across Massachusetts, is one of the first looks at readmissions for all payer types, rather than the Medicare fee-for-service population, which has been the main focus of the Center for Medicare & Medicaid Services' assessments. The data shows that unplanned readmissions throughout the state fell each year between 2011 and 2013, but with wide variation across categories, including payer type, discharge setting and patient age.

CHIA found 7 percent of patients account for a quarter of all hospitalizations and 59 percent of readmissions. The vast majority of these super-users were Medicare patients, who accounted for 40,357 of 58,674 patients, or 68.8 percent. These patients also tend to have limited access to care and complex needs, FierceHealthcare previously reported.

CHIA found patients 65 and older were at the highest risk for readmission, accounting for 53 percent of discharges and 57 percent of readmissions. Of these patients, the highest-risk subset involved patients 85 and older, who had a readmission rate of 17 percent, according to the report. Readmission rates were higher among patients discharged to skilled nursing facilities than those who were sent home.

The report also found distinct variations between the conditions that caused the most readmissions and those with the highest rates of readmission. Heart failure caused the most readmissions overall, with 23 percent of patients readmitted. Chronic obstructive pulmonary disease took second place with 21 percent, followed by septicemia and resultant infections with 18 percent. Prior research found 15 percent of heart failure patients are readmitted. Meanwhile, the conditions with the highest readmission rates were sickle cell anemia crisis, liver and/or intestinal transplant, and hepatic coma, all of which had rates of more than 25 percent.

To learn more:
- read the report (.pdf)