Hospital admissions and readmissions, being both costly and prevalent, have become a key policy issue. Furthermore, although patients may be admitted to the hospital for a variety of reasons, research shows that many admissions and readmissions are also preventable. Thus, reducing hospital readmissions is a way to both improve care and reduce avoidable costs. However, while hospital readmissions have been investigated in a variety of populations, including Medicare, there have been fewer studies in the Medicaid population.
A recent study, led by state Medicaid Medical Directors (MMD) and conducted by AcademyHealth, with funding support from the Agency for Healthcare Research and Quality (AHRQ), sought to contribute to better understanding of Medicaid readmissions and state-level efforts in addressing this issue. Having previously investigated antipsychotic medication use in Medicaid children and adolescents, a working group of states and investigators sought to characterize acute care hospital admissions and 30-day readmissions in the Medicaid population through a retrospective analysis. The team developed detailed definitions and specifications, as well as empty template tables for data entry. The form was emailed to states and those who chose to participate filled it out and sent aggregate data back to AcademyHealth for review and analysis. Nineteen states submitted data.
The study found that 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. State Medicaid payments for readmissions were substantial: they averaged $77 million per state for study states, and they represented 12.5 percent of the payments for all Medicaid hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. These five diagnostic groups in order of their prevalence are: mental and behavioral disorders; pregnancy, childbirth and their complications; diseases of the respiratory system, diseases of the digestive system, and diseases of the circulatory system. The two most prevalent diagnostic categories -- mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications together accounted for 31.2 percent of readmissions.
Because Medicaid has the largest number of beneficiaries among all U.S. payers and is growing even larger with the implementation of the Affordable Care Act, understanding the potential for improving hospital use in this population has particular importance. This study offers valuable new information about Medicaid hospitalizations: it allows MMDs to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement. Providing states with information about admissions and readmissions by diagnostic groupings enables a discussion of the interventions aimed specifically at these conditions. These interventions can range from better access to primary, behavioral or mental, or obstetrical care to more effective management of care transitions.
The study was published in the August issue of Health Affairs. Study investigators included MMDs, Judy Zerzan, M.D. (Colorado), and David Kelley, M.D. (Pennsylvania), as well as Tara Trudnak, Ph.D., Gerry Fairbrother, Ph.D., and Katherine Griffith, M.H.S., from AcademyHealth and Joanna Jiang, Ph.D. from AHRQ.