Readmission rates in the state of Florida: a reflection of quality?

High readmission rates are viewed by the Centers for Medicare & Medicaid Services as a quality of care determinant but it is unclear whether readmission rates per se reflect quality and the drivers of readmissions after hip arthroplasty remain unclear.

We therefore describe the effects of (1) insurance, discharge disposition, and mental health status as they relate to rates; (2) rehospitalization charges; and (3) reasons for readmissions.

We studied a cohort of all 27,019 patients who initially underwent hip arthroplasty in Florida (April 2009 to March 2010). Participants were identified using the All Patient-Refined Diagnosis-Related Group 301. Data were provided by the Agency for Health Care Administration and the Florida Hospital Association who with the Florida Orthopedic Society studied readmissions within 15 days. We extracted readmission rates and their reasons; original payers, discharge disposition, mental health status; and readmission charges.

The readmission rate in the first 15 days was 5%. Rates varied by type of insurance: self-pay/underinsured, Medicaid, and Medicare patients (6%) had higher rates than individuals with commercial insurance, HMO, or PPO (3%). Patients discharged to skilled nursing facilities (SNFs) had higher rates (7%) than patients discharged home with/without health care (both 3%). Patients with a mental health issue (10%) were readmitted more frequently than patients without it (5%). Medicare readmissions comprised 81% (USD 59,222,829) of the total readmission charges in this cohort. The most common reasons were infections (all 27%), hip arthroplasty (11%), and cardiovascular problems (9%).

Patients were more frequently readmitted if their payer was the government, they were discharged to a SNF, or they had a mental health disorder. Infections were the most common reasons for readmission. Our data suggest readmission rates alone do not necessarily reflect quality of care.