Heart failure stands out for costly readmissions

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 - healthcare cost

Congestive heart failure topped the list for 30-day readmissions of Medicare beneficiaries in 2011 and ranked among the top 10 high-volume conditions for two other payer categories in an analysis released in April.

Medicare penalizes hospitals for having higher than expected 30-day readmission rates for heart failure, acute MI and pneumonia under the Hospital Readmissions Reduction Program. The program is expected to expand in 2015 to include other conditions that the Centers for Medicare & Medicaid Services identifies as opportunities to improve care and lower costs.

“Identifying conditions that contribute to the total number of readmissions and related costs for all payers may aid healthcare stakeholders in deciding the conditions to target to maximize quality improvement and cost-reduction efforts,” wrote the authors of the Agency for Healthcare Research and Quality statistical brief.

Analysts used data from the Healthcare Cost and Utilization Project to calculate 30-day readmission rates for patients who were either insured through Medicare, Medicaid, private insurance or not insured in 2011. That year 3.3 million adults were readmitted to hospitals for a cost of $41.3 billion.

Medicare accounted for the majority of readmissions and cost, at 55.9 percent and 58.2 percent, respectively. Congestive heart failure was the most common condition for a Medicare readmission, with 134,500 beneficiaries rehospitalized for a total cost of more than $1.7 billion.

Cardiac dysrhythmia ranked fifth, with 69,400 readmissions and a cost of $835 million, and acute MI eighth, at 51,300 readmissions and a cost of $693 million.

Congestive heart failure took the biggest chunk of the Medicare readmission budget, at 7.3 percent of total costs.

Congestive heart failure also appeared in the top 10 list for Medicaid patients and uninsured patients. It ranked seventh for Medicaid readmissions (18,800 rehospitalizations at a cost of $273 million) and eighth for uninsured readmissions (3,600 and $43 million).

Coronary atherosclerosis was the only cardiovascular condition to make the list for insured patients, placing 10 th with 10,800 readmissions at a cost of $154 million.