Potentially Preventable Hospital Readmissions Among Medicaid Recipients: New York State, 2007

Introductionreadmissions are increasingly viewed as indicative of substandard quality of care, ranging from complications during the hospital stay or immediately afterward, incomplete treatment of the underlying medical problem during the hospitalization, or poor or no outpatient care. In addition to serving as one potential quality of care outcome measure, the Medicare Payment Advisory Commission (MEDPAC) has suggested that hospital readmission rates be linked to hospital reimbursement in the Medicare system. The increasing interest in linking payment to quality of care measures has led a number of states to consider linking hospital readmission rates to reimbursement, and Medicare to consider doing the same nationally. This brief report summarizes analyses based on New York State Medicaid administrative data for all recipients hospitalized during 2007. The Potentially Preventable Readmission (PPR) software created by 3M TM was used to estimate the number of hospital readmissions that might have been prevented. Since not all readmissions can be prevented, the PPR software uses clinical logic to link initial hospital admissions to subsequent readmissions within a specified time frame in order to identify clinically related readmissions that might have been prevented given appropriate initial inpatient or subsequent outpatient care. A more complete description of the logic used by the PPR software is provided at the end of this report. This brief addresses several questions. What was the estimated rate of potentially preventable readmissions for Medicaid recipients in 2007? What medical conditions at the initial admission were most frequently associated with subsequent PPRs? What medical conditions were present at readmission for recipients who experienced a PPR, and the Medicaid costs associated with these PPRs? In this brief, an inpatient event was considered managed care if it was an admission for a service included in the managed care benefit package. Carved out services not covered in the benefit package (e.g. a mental health admission for a Supplemental Security Income Medicaid recipient) were considered fee-for-service (FFS). Differences between the FFS and managed care defined in this way, and regional differences are also emphasized.