​Hospital readmissions within 30 days of discharge cost U.S. hospitals $50.7 billion between January 1 and November 31, 2013, and although Medicare patients accounted for more than half ($29.6 billion) of these costs, non-Medicare patients still accounted for a substantial amount ($21 billion), according to a study published in PLOS ONE on July 10, 2017. The authors retrospectively examined data from 2,006 nonfederal hospitals in 21 states, comparing rates, characteristics, and costs of 30-day readmissions and sorting by primary insurance type. Medicare-insured patients accounted for most of the 1,818,093 short-term readmissions (56%), followed by private-insured patients (18.3%), Medicaid-insured patients (17.2%), and self-pay patients (4.8%). According to the authors, the conditions that accounted for the largest numbers of readmissions included psychiatric or substance abuse disorders (24.0%), heart failure (22.9%), and septicemia (17.9%). The authors note that among patients older than 44 years, Medicaid patients had the highest odds of readmission, commonly due to psychiatric illnesses and substance abuse disorders. Additionally, Medicaid-insured patients accounted for the highest adjusted odds ratio for readmission in both the over-65 group and the 45 to 65 group.

HRC Recommends: Readmissions are a concern for quality, safety, and financial reasons. CMS imposes reimbursement penalties for high rates of readmission for heart failure, acute myocardial infarction, pneumonia (including patients with aspiration pneumonia and sepsis patients with pneumonia present on admission), acute exacerbation of chronic obstructive pulmonary disease, elective total hip and total knee arthroplasty, and coronary artery bypass grafting. An enterprise risk management approach to evaluating an organization's experience with readmissions can help to direct improvement efforts. Risk management and leadership should review the organization's readmissions statistics and use them to evaluate performance and guide improvement efforts. Risk managers, along with administrators, medical leadership, patient safety officers, and other key staff, should evaluate the organization's readmission rates and determine the best way to reduce preventable readmissions. Efforts may include measures to ensure high-quality, evidence-based care throughout the patient's stay; comprehensive discharge planning and teaching; and effective coordination and communication with other healthcare providers.