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High HCAHPS Scores Are Related to Lower Readmission Rates

Hospital Readmissions are a central focal point in healthcare discussion as an important factor for healthcare quality and finance. The cost of readmissions for Medicare patients alone is $26 billion annually, of which $17 billion are for return trips that were not necessary if patients received appropriate care originally. From 2007 through 2011, the national 30 day all cause hospital readmission rate averaged 19% (Gerhardt et al., 2013). Additionally, researchers from the Dartmouth Atlas (2013) project found that readmissions are closely linked to place of residence and the health system providing care. Results showed that the rate of readmission for patients discharged after a medical admission in 2010 varied from a high of 18.1 percent in Bronx, N.Y., to a low of 11.4 percent in Ogden, Utah.

Costs of Readmission

Rizzo (2013) calculated per-patient costs of readmission for CMS-tracked conditions using 2009 data. The cost was calculated using the average cost of a single readmission and the probability a patient is readmitted for that condition:

  1. Congestive heart failure (CHF)—the average cost per CHF readmission was $13,000, with a 25.1% readmission rate. This is 118% the cost of an initial admission for CHF.
  2. All-cause readmissions—the average cost of a readmission for any given cause was $11,200, with a 21.2% readmission rate.
  3. Heart attack—the average cost for a readmission after a heart attack was $13,200, with a 17.1% readmission rate. Costs vary with cause, ranging from an average of $7,600 (heart failure or shock, 13.4%) to $23,400 (scheduled angioplasty or bypass surgery, 11.8%). The average cost of a heart attack readmission was 64% the cost of an initial heart attack admission, which is $20,800 on average.
  4. Pneumonia—the average cost of a pneumonia readmission was $13,000, with a 15.3% readmission rate. This is 135% the cost of an initial pneumonia admission, which averaged $9,600.

As HCAHPS Scores Increase, Readmission Rates Decrease

HealthStream conducted a study of 30-day readmission rates for all clinical diagnoses using Centers for Medicare & Medicaid Services (CMS) data of up to 4,075 readmissions. The results showed that a number of HCAHPS category themes were significantly correlated with readmission rates. It is important to note that these readmission rates were negatively correlated with HCAHPS category scores. This means that as HCAHPS scores increased, readmission rates decreased. 

Interestingly, the CMS data results by bed size showed that the relationship between HCAHPS scores and readmission rates tended to be stronger for hospitals with 250-499 beds and hospitals with 500 or more beds, notably for readmission rates of heart failure and hospital wide all cause for the HCAHPS categories of discharge information, overall rating, and willingness to recommend.

Furthermore, hospitals with over 500 beds had higher readmission rate correlations with HCAHPS categories for certain health conditions. Heart Failure readmission rates had the highest correlations for the following HCAHPS categories: Pain Management, Discharge Information, Overall rating, Willingness to Recommend, Transition of Care, and HCAHPS composite score.

Readmissions Rates Are Related to HCAHPS Star Rating

Another way to investigate the relationship between HCAHPS scores and readmission rates is to utilize the CMS overall HCAHPS star rating of hospitals. Hospitals are awarded a star rating based on their HCAHPS scores: 1 star is lowest and 5 stars is the highest. For the purposes of this analysis, 1 & 2 star hospitals were grouped together and 4 & 5 hospitals were grouped together. Across all readmission rates examined, hospitals with 4 & 5 stars (better HCAHPS scores) had lower readmissions rates than hospitals with fewer stars. 

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References

Gerhardt, G., Yemane, A., Hickman, P., Oelschlaeger, A., Rollins, E., and Brennan, N. (2013). Medicare & Medicaid Research Review. Centers for Medicare & Medicaid Services, Vol. 3(2).

Rizzo, E. (2103). 6 stats on the cost of readmission for CMS-tracked conditions. Beckers Healthcare. http://www.beckershospitalreview.com/ quality/6-stats-on-the-cost-of-readmission-for-cms-tracked-conditions.html

Robert Wood Johnson Foundation. (2013). The revolving door: A report on U.S. hospital readmissions—An analysis of medicare data by the Dartmouth Atlas Project. The Dartmouth Institute for Health Policy and Clinical Practice.

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