Trends in Hospital Readmissions for Four High-Volume Conditions, 2009–2013: Statistical Brief #196

The Affordable Care Act established the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program (HRRP) to provide a financial incentive for hospitals to reduce preventable readmissions. Effective in 2013, the HRRP imposes a financial penalty for hospitals with excess rates of readmissions for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia among Medicare beneficiaries. In 2015, penalties also will be calculated based on readmissions for chronic obstructive pulmonary disease (COPD) and hip and knee replacements. CMS includes these conditions and procedures because of their high volume and costs.This Healthcare Cost and Utilization Project (HCUP) Statistical Brief examines trends from 2009 through 2013 for all readmissions following an admission for any cause, as well as for readmissions following an admission for four high-volume conditions targeted by the HRRP: AMI, CHF, COPD, and pneumonia. Readmission was defined as a subsequent hospital admission for any cause within 30 days following an initial hospital admission, referred to as the index stay. Because all-cause readmissions were examined, readmissions may or may not be related to the primary reason for admission during the index stay. Trends in the rate and aggregate cost of readmissions were examined overall and by expected payer of the index stay. Therefore, the expected payer of the readmission may be different from that of the index stay. Aggregate costs are those for the readmission only, not counting the cost of the index stay. Differences of greater than 5 percent are noted in the text.