Readmissions in Medicaid and Beyond: Physical and Mental Health

1. Readmissions in Medicaid and Beyond:Physical and Mental Health An AHRQ and MMDLN Benchmarking Study Jeffery Thompson, MD

2. Wide Variation Exists in Re-hospitalization rates (inter/intra State). Medicare 30-day rehospitalization rates vary from 13 percent to 24 percent by state.

3. Why do Re-hospitalizations Occur? • Hospitalizations account for one-third of the $2 trillion in total health care expenditures in the United States • In the majority of situationsare appropriate; however, approximately 28 percent—are avoidable. • They are symptomatic of multiple system defects system, including: • Timely or equitable access to care; • Effective handoffs and coordination of care; • Reliable and effective care; • Safe care; and • Patient-centered and appropriate end-of-life care. Experience and published evidence suggest that avoidable hospitalization rates can be reduced While WA Medicare rehospitalization rates are low a recent benchmarking of Medicaid shows that WA in the middle of the pack on 30 re-hospitalizations • current policy is non-payment for 7 day preventable readmissions) http://www.ihi.org/NR/rdonlyres/C0CAA410-D43E-4075-88ED-4601FDAF5579/0/STAARStateBasedStrategy.pdf

4. What the Issues with Readmissions: Top DRG and Diagnosis

5. What do we know works? Reengineered Hospital Discharge Program (Project RED) (Feb. 2009) Check off tools and making appts before discharge work to reduce readmissions

6. Policy Considerations Some approaches to align incentives for this work include the following: • Create incentives • Create incentives to communicate • Encourage efficiencies in coordination and communication • Decrease barriers to change (e.g., gain-sharing); • Implement catalysts for change (e.g., data transparency, payment reduction, “bundling”); and • Invest in enhancements for high-risk patients, particularly during transitions. Good overview of readmissions at: http://www.ahrq.gov/news/kt/red/readmissionslides/readslides-contents.htm