Administrative Memos

200001

FROM: Theodore O. Will, Chief Executive Officer
DATE: Jan 10, 2000
SUBJECT: Hospital Readmission Report
IPRO CONTACTS:

Kathy Terry, Ph. D., Director of Data Analysis, Extension 261

Enclosed please find your Hospital Readmission Report, based on our analysis of the New York State Medicare inpatient claims data. This report is the first in an ongoing Payment ErrorPrevention Program (PEPP) analytical series; it illustrates readmission patterns for your hospital compared to your peer grouping and to the state as a whole.

Statewide analysis of readmission patterns was selected as our first topic as a follow-up to the hospital readmission study, Monitoring Quality of Care and Overpayment Issues Associated with Hospital Readmissions under the Medicare Prospective Payment System, released by the Department of Health and Homan Services, Office of the Inspector General (OIG) in April, 1999,. The OIG studied same day/same hospital readmission patterns in the highest volume 18 states, including New York. With over 12,000 same day/same hospital readmissions valued at greater than $83 million, the OIG estimated more than $22 million in overpayments for 1996, with the greatest percentage of errors attributed to premature discharge.

While the enclosed report provides data specific to your hospital, it is only a high-level snapshot of your Medicare claims as they relate to readmissions within thirty (30) days. Additional hospital analysis may be warranted for you to determine if there are problematic areas requiring corrective action. You may wish to consider a study of your hospital readmission patterns by DRG, by ICD-9 diagnosis or procedure codes, or by hospital service. We have included a brief bibliography highlighting recent literature which may be helpful to you.

Please be aware, IPRO has selected a sample of readmission cases for data abstraction/review from those hospitals exceeding the statewide readmission rate of 12.6%. Subsequent hospital-specific information in regard to our findings will be provided at a later date.

Should you have any questions in regard to this report, please feel free to contact Andrea Goldstein, Vice President, Health Care Assessment or Dr. Kathy Terry. We are most interested in your comments in regard to the enclosed Readmission Report as well as your ideas for future focus areas that you feel would be useful to the hospitals. Please take a few moments to complete the attached IPRO-PEPP Readmission Report Feedback Form and return it to IPRO in the enclosed, stamped, self-addressed envelope.

Highlights of Recent Literature

In April 1999 the Office of the Inspector General (OIG) released Monitoring Quality of Care and Overpayment Issues Associated with Hospital Readmissions under the Medicare Prospective Payment System.1 This review analyzed same-day readmissions for calendar year (CY) 1996 for the top 18 States in the country, as identified by claim volume and expenditure. A principal conclusion was that the majority of the readmission errors identified were due to premature discharges. Follow-up analyses, reported in the same article, demonstrated a similar trend of costly readmissions for CY 1997. New York State (NYS) is included in the report as one of the top 18 states.

Past literature points to readmissions as indicators of poor quality of care during the hospital stay. However, recent literature on short-term readmissions diverges on the interpretation of a readmission as a sentinel marker for poor quality referencing other factors, such as billing errors.2-7

Issues of poor patient/family education as well as other aspects of discharge planning ranked among the top risk factors for a short-term readmission.2,4 Hospitals must assure that their patients and/or their support systems are made aware of and plan for patient after-care including such risk factors as medication administration, wound care, positioning, etc.

References

Monitoring Quality of Care and Overpayment Issues Associated with Hospital Readmissions under the Medicare Prospective Payment System. Office of the Inspector General; 1999. Technical report A-01-98-00504.
Marcantonio ER, McKean S, Goldfinger M, Kleefield S, Yurkofsky M, Brennan TA. Factors associated with unplanned hospital readmission among patients 65 years of age and older in a Medicare managed care plan. Am J Med. 1999;107(1):13-17.
Weissman JS, Ayanian JZ, Chasan-Taber S, Sherwood MJ, Roth C, Epstein AM, Hospital Readmissions and quality of care. Med Care 1999;37(5):490-501.
Caplan GA, Brown A, Croker WD, Doolan J. Risk of admission within 4 weeks of discharge of elderly patients from the emergency department-the DEED study. Discharge of elderly from emergency department. Age Aging. 1998;27(6):697-702.
Levitan N, Dowlati A, Remick SC, Tahsildar HI, Sivinski LD, Beyth R, Rimm AA. Rates of initial and recurrent thromboembolic dosease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicare (Baltimore). 1999;78(5):285-291.
Ashton CM, Kuykendall DH, Johnston ML, Wray NP. An empirical assessment of the validity of explicit and implicit process-of-care criteria for quality assessment. Med Care. 1999; 37(8):798-808.
Wray NP, Peterson NJ, Souchek J, Ashton CM, Hollingsworth JC, Geraci JM. The hospital multistay rate as an indicator of quality of care. Health Serv Res. 1999; 34(3):777-790.