OBJECTIVE:Descriptive analysis comparing changes in hospital inpatient readmissions to emergency department visits and observation stays that occurred within 30 days of an inpatient stay.POPULATION:Medicare fee-for-service (FFS) beneficiaries that had at least one acute hospital inpatient stay.DATA SOURCE:Using 100 percent of claims in the Chronic Condition Data Warehouse, we compare growth in annual readmission stays to post-hospitalization emergency department visits and observation stays that were not accompanied by an inpatient stay. Comparisons are performed at the national level and within the Dartmouth Hospital Referral Regions (HRRs).RESULTS:In calendar year 2012, the national, all-cause, 30-day hospital readmission rate among Medicare FFS beneficiaries was 18.5 percent, a significant decline from 19 percent in 2011, which was also the average rate over the previous five years. The number of index admission stays per-1,000 Medicare beneficiaries declined by 4.3 percent, from 283.4 in 2011 to 271.3 in 2012. On a per-1,000 beneficiary basis, the number of readmission stays declined by 6.8 percent, from 53.8 in 2011 to 50.1 in 2012. On the same per-beneficiary basis, the rate of outpatient visits to an emergency department occurring within 30 days of an index hospitalization remained similar at 23.5 in 2011 and 23.4 in 2012. Per-1,000 beneficiaries, the number of observation stays within 30 days of an index hospitalization increased by 0.3 percent, from 3.4 in 2011 to 3.7 in 2012.DISCUSSION:The reasons behind the decline in the Medicare readmission rate in 2012 are not yet clear. When looking at utilization changes in absolute terms, our findings suggest that the reduction in the nation-wide readmission rate observed in 2012 was not primarily the result of increases in either post-index ED visits or post-index observation stays.

Objective: Potentially avoidable hospitalizations have been identified by experts as leading to poor health outcomes and costly care.Potentially avoidable hospitalizations are particularly common among full-benefit dual eligible beneficiaries.This paper examines potentially avoidable hospitalizations rates by setting, state, and medical condition, and the average cost of these events.Methods: This analysis identifies potentially avoidable hospitalizations using diagnosis codes identified by an expert panel.Settings of care are determined using a timeline file, which assigns an individual to a specific setting on a particular day.Population/Data Source: The analysis uses several different datasets from the Chronic Conditions Data Warehouse.The study population includes fee-for-service beneficiaries who were eligible for both Medicare and full Medicaid benefits for at least one month during the calendar year.The study years are 2007 to 2009. Results:In 2009, among our study population, 26 percent of hospitalizations were potentially avoidable; and the rate was 133 per 1,000 person-years.Potentially avoidable hospitalizations were much more likely for those beneficiaries who were in institutions-16 percent of beneficiaries in our study population were in an institution, yet comprised 45 percent of all potentially avoidable hospitalizations.The range in rates across the states was considerable, with more than a threefold difference across states.Five conditions were responsible for nearly 80 percent of potentially avoidable hospitalizations.From 2007 to 2009, the national and state rates were fairly consistent. Discussion:This analysis indicates that the potentially avoidable hospitalization rate among MME beneficiaries was consistently high from 2007 to 2009.This bears monitoring in the future to see if the Centers for Medicare & Medicaid Services' various initiatives have led to a reduction in rates.

OBJECTIVE:Descriptive analysis of 30-day, all-cause hospital readmission rate patterns from 2007-2012.POPULATION:Medicare FFS beneficiaries experiencing at least one acute inpatient hospital stay.METHODS:Using Chronic Condition Data Warehouse claims, we estimate unadjusted, monthly, readmission rates for the nation, within the Dartmouth Hospital Referral Regions (HRR), and compare participating and non-participating hospitals in the Partnership for Patients (P4P) program (overall and by number of inpatient beds at each facility).RESULTS:From 2007 through 2011, the national 30-day, all-cause, hospital readmission rate averaged 19 percent. During calendar year 2012, the readmission rate averaged 18.4 percent. Of the 306 HRRs, rates in 166 HRRs fell by between 1 and 5 percent, while rates dropped by more than 5 percent in 73 HRRs, with the largest reduction in Longview, Texas. Rates increased by more than 1 percent in only 30 HRRs, with the largest increase in Bloomington, Illinois. Readmission rates at hospitals participating in the P4P program have been, on average, consistently lower than the rates at non-participating hospitals within all size categories except for the very smallest and largest hospitals, but rates at both participant and non-participant hospitals fell in 2012.DISCUSSION:Although claims data are not yet final for 2012, our analysis indicates that hospital readmission rates for all Medicare FFS beneficiaries dropped noticeably during the year. The reasons behind the apparent reduction are not yet clear and merit further investigation.