Chronic conditions and rehospitalization.

1. Chronic Conditions and
DataBrief: Rehospitalizations
Did you know…
In 2009, Medicare beneficiaries with 5
or more chronic conditions were more than
twice as likely to be rehospitalized within 30
days as all other Medicare beneficiaries who
were hospitalized?
DataBrief Series March 2012 No. 28
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2. Chronic Conditions and Rehospitalizations
Among Seniors
• The rehospitalization of Medicare beneficiaries is a frequently occurring and
significant problem.1
• Unplanned rehospitalizations can be dangerous and sometimes life-threatening.
They are also costly; in 2004, the estimated cost of unplanned rehospitalizations
was $17.4 billion.1
• In 2009, 38% of Medicare beneficiaries with 5 or more chronic conditions who
were hospitalized during the year were rehospitalized within 30 days, as compared
to 16% of all Medicare beneficiaries who were hospitalized during the year.2
• Similarly, rehospitalization rates at 60 and 90 days after an inpatient stay were
significantly higher for beneficiaries with 5 or more chronic conditions compared to
all Medicare beneficiaries who had an inpatient stay.2
1Jencks,Stephen, Mark Williams and Eric Coleman. “Rehospitalizations Among Patients in the Medicare Fee-For-Service Program.” New England
Journal of Medicine 360 (2009): 1418-1428.
2Avalere Health, LLC. Analysis of 2009 Medicare Standard Analytic Files. Excludes individuals who died in 2009.
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3. Rehospitalization Rates Increase With Time, Especially for Medicare
Beneficiaries With Multiple Chronic Conditions
Rehospitalization Rates for Medicare Beneficiaries With One or More
Inpatient Stays, 2009
60%
52%
50% 47%
40% 38%
30%
23%
20%
20% 16%
10%
0%
All Medicare Beneficiaries¹ Medicare Beneficiaries with 5+ Chronic Conditions¹
30-Day Rehospitalizations 60-Day Rehospitalizations 90-Day Rehospitalizations
1N = 4,355,540 total Medicare beneficiaries with one or more inpatient stays, 372,800 total Medicare beneficiaries with 5+ chronic conditions and one or more inpatient stays.
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4. About the data:
This analysis used 2009 Medicare A Clear Policy Connection
claims data to identify individuals
with chronic conditions, using a list
Rehospitalizations are potentially dangerous events for Medicare
of 21 common chronic conditions beneficiaries and are very costly to Medicare. Though some
derived from the Medicare Chronic rehospitalizations are unavoidable, others could be prevented by improving
Condition Working file. communication between patients and providers, reducing medication
errors, and improving coordination between hospitals, post-acute, and
Individuals were defined as having a long-term care providers.1 This is particularly critical for individuals with
rehospitalization if they had one or chronic conditions.
more hospital admissions for any
The Affordable Care Act (ACA) includes provisions to address
cause within 30 days, 60, or 90 days
rehsopitalizations as a means to improve care quality and reduce costs.
of a prior hospital admission. This One such provision will impose progressive reductions in Medicare
analysis is limited to individuals payments to hospitals with high 30-day rehospitalization rates beginning in
enrolled in the fee-for service, or October 2012.1 Another ACA provision established the Community-Based
traditional, Medicare program, and Care Transitions Program, which authorizes $500 million to test models for
improving care transitions from hospitals to other settings and reducing
excludes beneficiaries who died in
readmissions for high-risk Medicare beneficiaries through partnerships
2009. between hospitals and community-based organizations. The program
began in April 2011 and will run for five years. In November 2011, the
Centers for Medicare and Medicaid Services announced the first seven sites
selected for participation, representing communities in
Georgia, Ohio, Maine, Arizona, New Hampshire, and Illinois.2
1Healthcare.gov. Roadmap to Better Care Transitions and Fewer Readmissions. Accessed December 8,
2011 at: http://www.healthcare.gov/compare/partnership-for-patients/safety/transitions.html.
2Centers for Medicare and Medicaid Services. Medicare Demonstrations: Details of the Community- Based
Analytics powered by Avalere Health LLC Care Transitions Program. Accessed December 8, 2011 at:
https://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=CMS1239313.
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