Latest hospital readmissions data highlight the challenges posed by septicemia

Index admissions for circulatory system diseases and injuries were linked to the costliest readmissions per case.

Newly released federal data presents a snapshot of hospital readmissions in 2018, and one takeaway is the clinical and financial burden of septicemia.

For all diagnoses across payers, researchers reported a 30-day readmission rate of 14% and an average cost per readmission of $15,200. The findings were presented in an Agency for Healthcare Research and Quality report that examined 2018 data from the Nationwide Readmissions Database.

The largest number of readmissions was associated with index admissions for septicemia, which accounted for 314,600, or 8.3% of all readmissions. Septicemia, heart failure, diabetes and chronic obstructive pulmonary disease combined for about 20% of readmissions.

Septicemia also led to the most readmissions in each category of payer (Medicare, Medicaid, private insurance, self-pay/no-charge). Heart failure was among the top five causes for each payer.

Septicemia also accounted for 9.6% of aggregate readmission costs for Medicaid patients and 8.6% for self-pay/no-charge patients.

Frequent and costly sources of readmissions

Regarding which diagnoses at index admission most often led to readmissions, sickle cell trait/anemia ranked first at 36.1% across payers, as well as within Medicare (37.2%) and Medicaid (39.4%). Hepatic failure (34.9%) was another condition for which more than a third of index admissions led to readmissions.

The costliest diagnosis per subsequent readmission was complication of transplanted organs or tissue, at $27,000, followed by arterial dissections ($26,500) and scoliosis ($26,200).

By payer, the highest-cost readmissions were chronic rheumatic heart disease for Medicare ($25,800), acute hemorrhagic cerebrovascular disease for Medicaid ($23,500), complication of transplanted organs or tissue for private insurance ($31,200), and traumatic brain injury for self-pay/no-charge ($18,200).

“Across payers, the highest average costs of 30-day all-cause readmissions were associated with those index admissions primarily for circulatory system diseases and injuries, including complications of medical devices or procedures,” the report states.

Potential penalty for readmissions

The Hospital Readmissions Reduction Program (HRRP) cuts a hospital’s Medicare payment by up to 3% for high rates of avoidable readmissions across six conditions or procedures (acute myocardial infarction, COPD, heart failure, pneumonia, coronary artery bypass graft surgery, elective primary total hip arthroplasty/total knee arthroplasty). Readmission rates also are among the outcome measures published on the consumer-facing Hospital Compare site.

Of the six conditions and procedures that factor into the HRRP, three were among the top five diagnoses that led to 30-day readmissions for Medicare beneficiaries in 2018:

• Heart failure (178,000)
• COPD (78,000)
• Pneumonia (73,800)

Medicare accounted for 60% of readmissions across payers, with 2.3 million of the 3.8 million total readmissions.

A 2016 study in JAMA Internal Medicine concluded that about a quarter of all readmissions are preventable through steps such as better communication among healthcare teams and between healthcare professionals and patients.