Metrics Matter: What Does the Number of Hospital Discharges of Medicare Enrollees Reveal about Hospital Readmission Levels?

With the recent Republican election victories, there has been a loud call to repeal the new healthcare reform legislation. Hospitals have been one voice in this crowd requesting that the readmission penalties – effective in fiscal year 2013 – be eliminated. Their complaint is that hospitals shouldn’t be held accountable for patients who don’t follow discharge instructions. In this month’s Metrics Matter, we show that the ways communities have organized their healthcare delivery systems and the formal and informal practice protocols may actually play a larger role in an individual hospital’s level of readmission.

Number of Discharges from Short-Stay Hospitals per 1,000 Medicare Enrollees
 

Healthcare Market Resources analyzed 2008 Medicare Claims to determine the number of discharges from short-stay hospitals per 1,000 Medicare enrollees on a statewide basis. Based on our analysis, we can conclude the following:

  • The hospitalization rate among Medicare fee-for-service enrollees nationally averages 343 discharges per 1,000 enrollees.
  • The variation among states is significant, however, ranging from Hawaii with the lowest (201 discharges per 1,000 enrollees) to Alabama with the highest (412 discharges per 1,000 enrollees).
  • The wide variation among states is also demonstrated with the first quartile of states having an average of 389 discharges per 1,000 enrollees and the fourth quartile having 237 discharges – a 64% difference.
  • Since the unweighted average hospital discharge level (326) is below the weighted national average (343), it appears that the more populous states have higher levels of hospital usage. This is further supported when we look at the states in the fourth quartile, which are predominantly rural. Does this mean that people who have easier access to hospital care are more likely to use it?
  • Two of the states with high levels of hospitalization – Mississippi (398) and Alabama (412) – not only are known to have populations in poorer health nationally, but also have a history of state regulatory policies that limit the health resources available to their citizens.
  • The state with the second highest level of discharges is Maryland (402 discharges per 1,000 enrollees). This state has had a highly centralized hospital system, which closely coordinates care and access to resources. Further, the hospitals in this state are the only ones in the country on a separate Medicare reimbursement method (other than DRGs), which reflects how tightly the state of Maryland regulates its hospitals.

While overall population health can account for some of the differences among the states demonstrated in this metric, it appears that factors within the control of the health systems and state policymakers play a larger role. Under the present reimbursement system, hospitals are rewarded for readmissions occurring after the first 72 hours following discharge. Many readmissions are preventable. As the most powerful players in local healthcare delivery, hospitals must take a leadership role if these readmission trends are to be changed.

Email or call 215-657-7373 to learn more about this metric and the many ways you can use Healthcare Market Resources’ data to analyze industry and local market trends.