Readmissions in Medicaid and Beyond: Physical and Mental Health An AHRQ and MMDLN Benchmarking Study Jeffery Thompson, MD

Wide Variation Exists in Re-hospitalization rates (inter/intra State). Medicare 30-day rehospitalization rates vary from 13 percent to 24 percent by state.

Why do Re-hospitalizations Occur? Hospitalizations account for one-third of the $2 trillion in total health care expenditures in the United States In the majority of situations are appropriate; however, approximately 28 percent—are avoidable. They are symptomatic of multiple system defects system, including: Timely or equitable access to care; Effective handoffs and coordination of care; Reliable and effective care; Safe care; and Patient-centered and appropriate end-of-life care. Experience and published evidence suggest that avoidable hospitalization rates can be reduced While WA Medicare rehospitalization rates are low a recent benchmarking of Medicaid shows that WA in the middle of the pack on 30 re- hospitalizations current policy is non-payment for 7 day preventable readmissions)

What the Issues with Readmissions: Top DRG and Diagnosis

What do we know works? Reengineered Hospital Discharge Program (Project RED) (Feb. 2009)

Policy Considerations Some approaches to align incentives for this work include the following: Create incentives Create incentives to communicate Encourage efficiencies in coordination and communication Decrease barriers to change (e.g., gain-sharing); Implement catalysts for change (e.g., data transparency, payment reduction, “bundling”); and Invest in enhancements for high-risk patients, particularly during transitions. Good overview of readmissions at: contents.htm