Readmissions for acute MI, heart failure are expensive, lead to long hospital stays

For the past few years, CMS has tracked 30 readmissions after an index hospitalization of acute MI, heart failure, chronic obstructive pulmonary disease (COPD) and pneumonia. The agency bases hospitals’ reimbursement in part on how well they keep patients healthy and out of the hospital.

Readmissions for non-Medicare patients and in other settings are not as closely monitored, although a database analysis suggests that patients spend nearly a week in the hospital and cost nearly $10,000 per readmission.

For patients readmitted within 30 days, the estimated mean length of stay was 5.7 days for patients who had an acute MI as their index hospitalization and 6.4 days for patients who had heart failure as their index hospitalization. The estimated mean cost per readmission was $9,424 and $9,051, respectively.

Lead researcher Florian B. Mayr, MD, MPH, of the Center for Health Equity Research and Promotion and the VA Pittsburgh Healthcare System in Pittsburgh, and colleagues published their results online in JAMA on Jan. 22.

The researchers analyzed data from the 2013 Nationwide Readmissions Database, which included acute care hospitalizations from 21 states. The database represents 49 percent of inpatient use in the U.S.

Of the nearly 1.2 million index admissions, 12.2 percent were for sepsis, 1.3 percent were for acute MI, 6.7 percent were for heart failure, 4.6 percent were COPD and 5 percent were for pneumonia. Of the patients with a sepsis index admission, 0.7 percent had diagnostic codes that met CMS criteria for acute MI, 3.4 percent met the CMS criteria for heart failure, 3.3 percent met the CMS criteria for COPD and 7.5 percent met the CMS criteria for pneumonia.

The mean length of stays for unplanned 30-day readmissions were 7.4 days following a sepsis hospitalization, 5.7 days following an acute MI hospitalization, 6.4 days following a heart failure hospitalization, 6.7 days following a pneumonia hospitalization and six days following a COPD hospitalization.

The estimated mean costs per readmission were $10,070 following a sepsis hospitalization, $9,424 following an acute MI hospitalization, $9,051 following a heart failure hospitalization, $9,533 following a pneumonia hospitalization and $8,417 following a COPD hospitalization.

The results were similar when the researchers performed sensitivity analyses using CMS definitions for principal discharge diagnoses.

Based on that criteria, the mean length of stays for unplanned 30-day readmissions were 7.6 days following a sepsis hospitalization, 6.0 days following an acute MI hospitalization, 6.5 days following a heart failure hospitalization, 6.9 days following a pneumonia hospitalization and 6.3 days following a COPD hospitalization.

The estimated mean costs per readmission were $10,828 following a sepsis hospitalization, $9,530 following an acute MI hospitalization, $9,248 following a heart failure hospitalization, $9,749 following a pneumonia hospitalization and $8,677 following a COPD hospitalization.

The researchers mentioned a few limitations of the study, including that the database could not follow-up patients across states. Thus, the readmission rates might have been underestimated. They also noted that readmission rates and cost estimates could vary based on sepsis definitions.