Mission Hospital’s Super Utilizers Contributed 43% to the Hospital’s Total Readmission Rate
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By: Emily Carpintero Jan. 04, 2018
Dexur’s recent analysis of CMS Medicare claims data for the time period of January 2016 through December 2016 showed that Mission Hospital’s Medicare super utilizers contributed 42.68% to the hospital’s readmissions. Dexur analysts identified the hospital’s Medicare inpatient super utilizers percentage of discharges, their contribution to LOS, their contribution to revenue, and their contribution to readmissions. Super utilizers are responsible for nearly half of the total cost of public healthcare due to their multiple emergency department visits and multiple hospital admissions. Super utilizers contribution to LOS, revenue, and readmission rate of a hospital are relevant metrics for healthcare professionals to create and implement practices that lead to positive clinical and economic outcomes. The graph below depicts the percentage of revenue contributed by Medicare inpatient super utilizers for six different hospital categories.
Percentage of Revenue Contributed from Super Utilizers
The three highest volume discharging hospital divisions for Medicare inpatients were cardiovascular, orthopedics, and pulmonology. Pulmonology discharges had the highest percentage of super utilizers at 21.76%, which was higher than the cardiovascular and orthopedic discharges by 5.62% and 14.55%, respectively. The cardiovascular division earned the highest payment per day from super utilizers at $1,938. The orthopedics division earned only $37 less than the cardiovascular division, but the pulmonology division earned $406 less. The pulmonology division again had the for highest contribution to LOS from super utilizers at 23.58%, this was higher than the cardiovascular and orthopedic divisions by 2.6% and 11.4%, respectively. The pulmonary division also led with the highest percentage of revenue and readmissions from super utilizers. Its super utilizers contributed 24.72% of Mission Hospital’s total revenue, and 55.07% to the hospital’s readmission rate. The cardiovascular super utilizers contributed 7.86% less revenue than the pulmonology super utilizers, while the orthopedics super utilizers contributed 16.24% less. Cardiovascular super utilizers contributed 43.9% to the hospital readmission rate, while only 28.78% of orthopedic super utilizers contributed.
Mission Hospital’s commitment to quality care by participating in several state and national quality reporting programs including: Joint Commission, NC Hospital Quality, Hospital Compare and Health Grades - to ensure they are always improving their standards of care. They are the only Level 2 Trauma Center in their region and also specialize in heart care, cancer care, neuroscience and orthopedics. Super utilizers and the metrics they contribute to do not necessarily speak to the quality of care provided, but rather on the patient population’s health. There is a significant difference between percentage of LOS contribution and percentage of revenue contribution in two of the three divisions which suggests that the super utilizer count may actually be costly to the hospital.
| Category | Total Hospital Discharges | % of Discharges from Super Utilizers | Payment per Super Utilizer Day | Hospital % of LOS from Super Utilizers | Hospital % of Revenue from Super Utilizers | Hospital % of Readmissions from Super Utilizers |
|---|---|---|---|---|---|---|
| All-Inpatient | 15,368 | 16.04% | $1,787 | 20.11% | 16.86% | 42.68% |
| Cardiovascular | 3,699 | 16.14% | $1,938 | 20.98% | 15.37% | 43.9% |
| Orthopedics | 2,287 | 7.21% | $1,901 | 12.18% | 8.48% | 28.78% |
| Pulmonology | 1,719 | 21.76% | $1,532 | 23.58% | 24.72% | 55.07% |
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- Total discharges, percentage of super utilizers, payment per super utilizer day, percentage of LOS from super utilizers, percentage of revenue from super utilizers and percentage of readmissions from super utilizers for each hospital category
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