The latest on Medicaid readmission rates

Hospital readmissions present a key policy issue for clinical leaders of state Medicaid programs. A recent study led by state Medicaid medical directors and conducted by AcademyHealth with support from and the Agency for Healthcare Research and Quality (AHRQ) sought to examine hospital admissions and readmission and understand the prevalence, costs, and clinical reasons for admissions and readmissions in the Medicaid population. This analysis allows Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement

Participating states received detailed specifications and definitions and were asked to submit aggregated state data. Nineteen states submitted data.

Findings indicate that Medicaid readmissions were both prevalent and costly. The 30-day Medicaid readmissions rates for the 19 participating states varied from 5.5 percent to 11.9 percent, with an average of 9.4 percent. Readmissions represented 12.5 percent of Medicaid payments for all hospitalizations and averaged $77 million per state. Readmissions were driven by five diagnostic groups that accounted for 57 percent of readmissions and 49 percent of hospital payments for readmissions.

The most prevalent diagnostic groups were mental and behavioral disorders; pregnancy, childbirth, and their complications; and diseases of the respiratory, digestive, and circulatory systems. Mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications together accounted for 31.2 percent of readmissions.

Providing states with information about admissions and readmissions by diagnostic groupings enables a discussion of the interventions aimed specifically at these conditions. Findings highlighted the differences between hospital diagnoses in the Medicaid and Medicare populations and emphasized that traditional disease management programs, such as those used in Medicare, do not typically focus on the most prevalent conditions among Medicaid beneficiaries. Policies and programmatic interventions need to be directed toward system-level management of both physical and behavioral conditions for Medicaid recipients.

Hospitals working at any level of Medicaid readmission reduction efforts can benefit from implementing AHRQ’s Hospital Guide to Reducing Medicaid Readmissions, an evidence-based resource which includes 13 online tools to help acute care facilities customize their Medicaid readmissions’ reduction strategies.

Republished with permission of the Altarum Institute.