Nearly 30% of Readmissions are to a Different Hospital From the Index Stay

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This article is part of a series that highlights challenges that hospitals face by not having access to out-of-hospital data and the patient journey. See prior articles in the series here:

Nearly 60% of Deaths for CMS Mortality Measures Happen Outside the Index Stay

20-40% of Deaths for CMS Pneumonia, HF, AMI and COPD 30 Day Mortality Measures have an Hospice Interaction

Hospitals face challenges in tracking CMS (Centers for Medicare & Medicaid Services) 30-Day readmissions due to the limitations of data. The 30-day Readmission measure is calculated based on the number of patients who are readmitted within 30 days of their initial hospital admission. However, hospitals lack access to comprehensive out-of-hospital information, making it difficult for them to track these measures accurately. Dexur is an approved purchaser of Medicare claims data and which allows it to evaluate patient outcomes, identify patterns and trends, and provide a more complete picture of healthcare utilization and performance. This data can be instrumental in identifying areas for improvement, developing strategies to reduce mortality and readmissions, optimizing resource allocation, and enhancing the overall quality of care.

To demonstrate the gap in potential internal hospital data, Dexur analyzed data and found that nearly 30% of readmissions are to a different hospital from the index stay, it suggests that a significant portion of patients who are readmitted end up receiving care at a hospital other than the one where they had their initial stay. Among all the CMS Readmission measures, the top three measures with the highest out-of-hospital readmission rates are THA/TKA with a 37% readmission rate, AMI with a 31% readmission rate, and CABG with a 29% readmission rate. These figures indicate the proportion of patients who are readmitted to the hospital end up receiving care at a hospital that is not the same as the one where they were initially admitted.

Measure 30 Day Readmissions - Any Hospital- Observed Rate - Dexur 30 Day Readmissions Back to Same Hospital - Observed - Dexur % of Total Readmissions to Non Index Hospital
THA/TKA 4.48% 2.82% 37%
AMI 14.43% 9.96% 31%
CABG 11.34% 8.04% 29%
Pneumonia 17.15% 12.63% 26%
Heart Failure 20.26% 15.17% 25%
COPD 19.43% 14.81% 24%

How Dexur platform helps in tracking in-hospital and out-of-hospital Readmissions:

Dexur has the advantage of being an approved purchaser of Medicare claims data. Medicare claims data contains a wealth of information that encompasses the full patient journey, including data from both in-hospital and out-of-hospital settings. By analyzing this comprehensive dataset, Dexur can gain insights into the factors that impact measures such as 30-day mortality, 30-day readmissions, MSPB (Medicare Spending per Beneficiary), and EDAC (Excess Days in Acute Care).

Considering the small difference between the 10th and 90th percentile performance in hospitals, it's crucial to take appropriate actions to address out-of-hospital readmissions. Therefore, Dexur recommends the following actions to account for these out-of-hospital readmissions:

  1. Set up Evidence Based Quality Management to Tracking intervention of both In and Out Hospital Outcomes: Dexur emphasizes the importance of tracking both in-hospital and out-of-hospital outcomes. This includes monitoring readmission rates during the initial hospital stay as well as within a specified timeframe after discharge. By capturing comprehensive data on readmissions, hospitals can gain insights into the effectiveness of their interventions and identify areas for improvement.

  2. Set up Multiple Goals: Dexur recommends establishing multiple goals to address out-of-hospital readmissions. This involves identifying key performance indicators and targets related to readmission rates, both within the hospital and after discharge. By setting specific goals, hospitals can focus on improving outcomes and reducing readmissions across the continuum of care.

  3. AI-Driven Insights: Dexur leverages artificial intelligence (AI) algorithms and advanced analytics to derive insights from healthcare data. By analyzing vast amounts of data, Dexur can provide hospitals with actionable insights, such as identifying factors that contribute to readmissions, predicting high-risk patients, and uncovering opportunities for quality improvement and cost reduction.

  4. Risk Factor Assessment: Dexur's expertise in healthcare analytics allows it to assess and quantify risks associated with specific patient populations or procedures. By analyzing data and identifying risk factors using Boil The Ocean RWE Approach, Dexur can help hospitals develop risk assessment strategies to mitigate potential complications, readmissions, or adverse events.

  5. Research of Best Practices: Dexur utilizes its access to Medicare claims data to conduct research and analysis on various healthcare practices. By studying patterns and outcomes, Dexur can identify best practices and benchmarks that hospitals can learn from and implement to improve their performance and patient outcomes.

By implementing these recommendations, hospitals can optimize their efforts to reduce out-of-hospital readmissions. Setting multiple goals and tracking both in-hospital and out-of-hospital outcomes provide a comprehensive view of performance. Additionally, utilizing a single platform for interventions can enhance efficiency and coordination among healthcare teams.