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Maryland Hospital Preventable Re-Admissions (MHPR)

Overview

Hospital readmissions are sometimes indicators of poor care or missed opportunities to better coordinate care. Research shows that specific hospital-based initiatives to improve communication with beneficiaries and their other caregivers, coordinate care after discharge, and improve the quality of care during the initial admission can avert many readmissions. For Medicare, readmissions contribute significantly to that cost of care as 18% of all Medicare patients discharged from the hospital have a readmission within 30 days of discharge, accounting for $15 billion in spending nationally (Medpac 2007). HSCRC is designing the MHPR initiative to reward those efforts that reduce the number of readmissions and that also increase the quality of care and decrease cost.

While not all of readmissions are avoidable, many clearly are. For the MHPR proposed initiative, HSCRC is using the Potentially Preventable Readmissions (PPR) methodology developed by 3M Health Information Systems which defines readmissions as return hospitalizations that may result from deficiencies in the process of care and treatment (readmission for a surgical wound infection) or lack of post discharge follow-up (prescription not filled) rather than unrelated events that occur post discharge (broken leg due to trauma).

In Maryland, based on analysis of 2007 readmission data using the PPR methodology:

The top performing hospitals had risk/severity adjusted 15-day rates of readmission just below 4%
The bottom performing hospitals had risk/severity adjusted 15-day rates of readmission just above 8%
The 15-day readmission rate was 6.74%
The 30-day readmission rate was 9.81%
For readmission in 15 days, there were $430.4 million (5.3%) estimated associated charges
For readmissions in 30 days there were $656.9 million (8.0%) estimated associated charges

HSCRC is currently working on additional analyses of PPR data with specific focus on establishing an algorithm that reliably matches patients across readmissions and hospitals.

Consistent with the MHAC methodology, the MHPR would provide a system of payment incentives based on a hospital’s actual number of readmissions versus a statewide target rate for each by APR DRG, by severity of illness (SOI) category. Under this approach, hospitals will face strong financial incentives to reduce rates.

In addition to implementing payment incentives to lower readmission rates, to help hospitals to identify and adopt strategies to reduce readmissions, HSCRC also plans to form partnerships that support the alignment of efforts across all those who can influence the readmission outcome of care—hospitals, nursing homes, home health providers, payers, etc—through improved collaboration and integration in the delivery of health care.

For full details of the MHPR Initiative, click on the links below under Policy Papers, Press Releases, Quality Reports and Analyses.

Policy Papers, Press Releases, Quality Reports and Analyses.

Updated Draft Recommendation (January 2011)

MHPR Workgroup Meeting Materials

Please click here to email questions or inquiries about HSCRC’s Quality Improvement Initiatives or contact Dianne Feeney by telephone at 410-764-2605.