You won’t get much argument from leaders at provider organizations about the damages—both financial and clinical—caused by preventable hospital readmissions. Every year, the Centers for Medicare and Medicaid Services is hit for $17.5 billion for readmitted Medicare patients.
Readmissions hurt both government and commercial payers. For commercial payers, the monetary impact is significant. According to an Optum analysis of 5.4 million commercial and 900,000 retired covered lives, the average readmission cost is about 37 percent higher than an average hospital admission.
Next year, some of Medicare’s Pioneer ACOs are transitioning from a shared savings/shared losses model to a population-based payment system that means they’ll bear the full brunt of costs for unnecessary readmissions, not just a percentage of them. They too must look harder at ways to cut preventable readmissions or risk paying the full costs for these patients’ care.
But readmissions aren’t ACOs’ only concern. Any type of patient rebound is a negative outcome for value-based organizations such as ACOs. The Optum study found that 30-day emergency room return rates averaged about six percent among commercial patients, with an average cost of $1,900. That’s big money, which gets even bigger when the patient moves from a rebound situation to readmission.
Over my next few posts, I will share perspectives on rebounds and readmissions from organizations that are developing integrated care transition programs to address the root causes of these problems. We’ll examine readmissions from social, system, provider and patient levels, and see how care coordinators are getting to the heart of this expensive, yet addressable, issue.
If you want to get the full story now, please download the white paper: “Preventing Patient Rebound: Value-based Care Organizations Should Focus on More Than Just Readmissions.”