The existence of CMS readmission penalties compels hospitals to better prepare Medicare patients for post-hospital care at home or in the community. However, focusing readmission prevention strategies only on those 65 and older is shortsighted. As illustrated in Table 1 below, 47% of patients who returned to the hospital more than one time are under age 65. Data for the chart was pulled from VHHA’s hospital-wide readmission database for the third quarter of 2015 – it tracks patients back to the fourth quarter of 2012. Looking at the cases among the youngest demographic group, a picture of developing chronic disease and poverty emerges. At retirement, it is unusual for a person to have just one chronic disease. Patients most likely to return to a hospital in Virginia have three or more chronic diseases. Diabetes, hypertension, heart disease, and renal failure often begin years before Medicare eligibility, and they often coexist. Readmitted patients are more likely to reside in poorer communities where there are fewer options for consistent ambulatory or coordinated care. Young readmission patients are more likely to be uninsured or Medicaid beneficiaries than to be insured. That circumstance can limit access to preventative or regular health care services. As people age, lifestyle choices and environment start to take their toll, often well before people reach age 65. For this reason, addressing readmissions using a population health approach that looks beyond disease or age offers more opportunity for prevention.
(Table 1 excludes patients who, within a three-year period, only returned to a hospital once within 30 days of discharge. Seventy-two patients that returned two or more times were excluded from the analysis because their age fell between the two age ranges.)
Understanding readmission data, coupled with an understanding of why patients return to the hospital, are key first steps in preventing readmissions. To assist Virginia hospitals in reducing readmissions, VHHA has partnered with the American Hospital Association’s Health Research & Education Trust for the Hospital Engagement Network (AHA/HRET HEN) in an effort to reduce all readmissions (not just Medicare readmissions) by 20 percent as of September 2016. As part of this program, Virginia hospitals have received a Readmissions Change Package that helps identify drivers for readmissions, and that suggests specific actions for improvement in those areas. Other readmissions strategies can be found on the HRET HEN website. (4/8)