Medicare beneficiaries most likely to be readmitted

Area of Science:

• Health Services Research
• Geriatric Medicine
• Health Economics

Background:

• Legislation mandates reduced Medicare payments for hospitals with high 30-day readmission rates.
• Effective strategies for identifying high-risk patients for care coordination are lacking.
• Hospital readmissions represent a significant cost to the Medicare program.

Purpose of the Study:

• To identify patient and hospital factors predicting 30-day readmission rates among Medicare beneficiaries.
• To inform targeted care coordination strategies for reducing hospital readmissions.

Main Methods:

• Analysis of a 5% sample of Medicare fee-for-service beneficiaries from January-September 2008.
• Utilized administrative data from the Centers for Medicare and Medicaid Services (CMS).
• Employed multiple regression analysis including patient demographics, comorbidities, and hospital characteristics.

Main Results:

• Beneficiaries with 10+ chronic conditions were over 6 times more likely to be readmitted.
• This group (8.9% of beneficiaries) accounted for 50.2% of all readmissions.
• Beneficiaries with 5-9 chronic conditions had a 2.5 odds ratio for readmission and accounted for 45% of readmissions.

Conclusions:

• The number of chronic conditions is a strong predictor of 30-day Medicare readmissions.
• A small percentage of beneficiaries with multiple chronic conditions drive a disproportionately large share of readmissions.
• Targeting care coordination for patients with multiple chronic conditions may effectively reduce readmission rates.