6 Stats on the Cost of Readmission for CMS-Tracked Conditions
Readmissions are both a clinical and financial problem. CMS began penalizing hospitals for 30-day readmissions Oct. 1, 2012 at 1 percent, upping the penalty rate to 2 percent for fiscal year 2014. While the average penalty imposed has dropped .04 percent between 2012 and 2013, the stakes have gotten higher: CMS will increase the maximum penalty for excess readmissions to 3 percent for fiscal year 2015.
Also new in fiscal year 2015 are additional conditions for which the agency will track readmissions rates. They include hip and knee replacements as well as chronic lung disease.
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The Healthcare Cost Utilization Project has been crunching the numbers on spending and healthcare use for the last decade. Several of the project's statistical briefs analyze the national cost of readmissions various conditions. Here are the per-patient costs of readmission for CMS-tracked conditions. Conditions are organized by the expected value of their cost, calculated using the average cost of a single readmission and the probability a patient is readmitted for that condition:
1. Congestive heart failure ("Statistical Brief #142," 2009 data) — The mean cost per CHF readmission is $13,000, with a 25.1 percent readmission rate. This is 118 percent the cost of an initial admission for CHF, which costs $11,000 on average.
2. All-cause readmissions ("Statistical Brief #142," 2009 data) — The average cost of a readmission for any given cause is $11,200, with a 21.2 percent readmission rate.
3. Heart attack ("Statistical Brief #140, 2009 data) — The average cost for a readmission after a heart attack is $13,200, with a 17.1 percent readmission rate. Costs vary with cause, ranging from an average of $7,600 (heart failure or shock, 13.4 percent) to $23,400 (scheduled angioplasty or bypass surgery, 11.8 percent). The average cost of a heart attack readmission is 64 percent the cost of an initial heart attack admission, which is $20,800 on average.
4. Pneumonia ("Statistical Brief #142," 2009 data) —The average cost of a pneumonia readmission is $13,000, with a 15.3 percent readmission rate. This is 135 percent the cost of an initial pneumonia admission, which averages $9,600.
5. Chronic Obstructive Pulmonary Disease ("Statistical Brief 121," 2008 data) —The average cost for a COPD readmission from COPD as a principle diagnosis is $8,400, with a readmission rate of $7.1 percent. The average cost of a CODP readmission from a diagnosis including COPD is $10,900, with a 17.3 percent readmission rate. The average COPD readmission costs 118 percent of an initial COPD admission, which averages $7,100.
6. Joint Replacement ("Statistical Brief 142," 2009 data) — The cost of a total hip replacement readmission averages $12,300, with an 8.2 percent readmission rate. An initial hip replacement admission averages $18,500. The cost of a total knee replacement readmission averages $10,200, with a 5.1 readmission rate. An initial knee replacement readmission averages $16,500.
While all-cause readmissions have been declining in 2013, the study of best practices for reducing readmissions remains an area for growth and innovation.
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