Hospital readmission

A hospital readmission is an episode when a patient who had been discharged from a hospital is admitted again within a specified time interval. Readmission rates have increasingly been used as an outcome measure in health services research and as a quality benchmark for health systems. Hospital readmission rates were formally included in reimbursement decisions for the Centers for Medicare and Medicaid Services (CMS) as part of the Patient Protection and Affordable Care Act (ACA) of 2010, which penalizes health systems with higher than expected readmission rates through the Hospital Readmission Reduction Program. Since the inception of this penalty, there have been other programs that have been introduced, with the aim to decrease hospital readmission. The Community Based Care Transition Program, Independence At Home Demonstration Program, and Bundled Payments for Care Improvement Initiative are all examples of these programs. While many time frames have been used historically, the most common time frame is within 30 days of discharge, and this is what CMS uses.

Hospital readmissions first appeared in the medical literature in 1953 in work by Moya Woodside examining outcomes in psychiatric patients in London. Gradually, health services research increasingly examined hospital readmissions, in part as a response to rising health care costs and a recognition that certain groups of patients were high consumers of health care resources. These patients often had multiple chronic conditions and were repeatedly hospitalized to manage them. Over time, hospital readmission rates have become a common outcome in health services research, with a large body of literature describing them, including their frequency, their causes, which patients and which hospitals are more likely to have high rates of readmissions, and various methods to prevent them.

In 2007, the Centers for Medicare and Medicaid Services (CMS) put forth a report to Congress called "Promoting Greater Efficiency in Medicare." In its section on readmissions, CMS made the case for closer tracking of hospital readmissions and tying reimbursement to lowering them, citing a 17.6% 30-day readmission rate for Medicare enrollees in 2005, at a cost of $15 billion. The section concluded with several policy recommendations, including public reporting of hospital readmission rates as well as a number of reimbursement structures that would incentivize a reduction in readmission rates. In 2009, CMS began publicly reporting readmission rates for myocardial infarction, heart failure, and pneumonia for all non-federal acute care hospitals. In an effort to use readmission as a measure of hospital quality, CMS contracted with the Yale-New Haven Services Corporation/Center for Outcomes Research and Evaluation (CORE) to develop a hospital-wide readmission (HWR) measure, which it began publicly reporting on Hospital Compare in 2013.

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