Medicare Readmission Rates by State: Prepared for the ...

[Pages:55]Medicare Readmission Rates by State: Prepared for the Alliance for Home Health Quality and Innovation

Avalere Health | An Inovalon Company January, 2016

Medicare FFS Readmissions Among Post-Acute Care Users, National

30-day Readmission Rates for Top 20 Most Common MS-DRGs Discharged from Hospital to Selected Post-Acute Care (PAC) Settings, by Setting, 2014

MS-DRG Major joint replacement or reattachment of lower extremity w/o mcc Septicemia or severe sepsis w/o mv 96+ hours w mcc Heart failure & shock w mcc Heart failure & shock w cc Hip & femur procedures except major joint w cc Kidney & urinary tract infections w/o mcc Intracranial hemorrhage or cerebral infarction w cc or tpa in 24 hrs Renal failure w cc Septicemia or severe sepsis w/o mv 96+ hours w/o mcc Simple pneumonia & pleurisy w mcc Simple pneumonia & pleurisy w cc Cellulitis w/o mcc Renal failure w mcc Chronic obstructive pulmonary disease w mcc Pulmonary edema & respiratory failure Kidney & urinary tract infections w mcc Misc. disorders of nutrition, metabolism, fluids/electrolytes w/o mcc Esophagitis, gastroent & misc. digest disorders w/o mcc Intracranial hemorrhage or cerebral infarction w mcc G.I. Hemorrhage w cc

% of Home Health Users Readmitted

Within 30 Days 3.54% 21.16% 25.23% 23.11% 7.90% 18.09% 13.68% 22.44% 16.82% 20.52% 17.16% 13.22% 25.42% 22.47% 23.31% 21.70% 21.51% 20.28% 18.44% 17.65%

% of SNF Users Readmitted Within

30 Days 6.83% 22.14% 25.43% 22.75% 10.86% 13.90% 14.58% 19.63% 16.75% 21.39% 16.82% 13.55% 23.16% 23.12% 24.88% 16.90% 15.19% 16.37% 20.69% 17.78%

Source: Avalere Health, analysis of Medicare Standard Analytic Files, 2014 *Analysis includes Medicare Part A claims only.

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Note: FFS is fee-for-service. CC is complication or comorbidity. MCC is major complication or comorbidity. SNF is Skilled Nursing Facilities.

Medicare FFS Readmissions Among Post-Acute Care Users, Alaska

30-day Readmission Rates for Top 20 Most Common MS-DRGs Discharged from Hospital to Selected Post-Acute Care (PAC) Settings, by Setting, 2014

MS-DRG Major joint replacement or reattachment of lower extremity w/o mcc Septicemia or severe sepsis w/o mv 96+ hours w mcc Heart failure & shock w mcc Heart failure & shock w cc Hip & femur procedures except major joint w cc Kidney & urinary tract infections w/o mcc Intracranial hemorrhage or cerebral infarction w cc or tpa in 24 hrs Renal failure w cc Septicemia or severe sepsis w/o mv 96+ hours w/o mcc Simple pneumonia & pleurisy w mcc Simple pneumonia & pleurisy w cc Cellulitis w/o mcc Renal failure w mcc Chronic obstructive pulmonary disease w mcc Pulmonary edema & respiratory failure Kidney & urinary tract infections w mcc Misc. disorders of nutrition, metabolism, fluids/electrolytes w/o mcc Esophagitis, gastroent & misc. digest disorders w/o mcc Intracranial hemorrhage or cerebral infarction w mcc G.I. Hemorrhage w cc

% of Home Health Users Readmitted

Within 30 Days 5.22% 21.43% 20.00% 18.18% 0.00% 25.00% 0.00% 66.67% 11.11% 0.00% 14.29% 0.00% 0.00% 0.00% 0.00% 0.00% 50.00% 0.00% 0.00% n/a1

% of SNF Users Readmitted Within

30 Days 10.20% 14.29% 0.00% 0.00% 17.07% 0.00% 7.14% 33.33% 0.00% 0.00% 50.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

1. n/a indicates no cases were discharged to home health for the DRG in 2014

Source: Avalere Health, analysis of Medicare Standard Analytic Files, 2014

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*Analysis includes Medicare Part A claims only.

Note: FFS is fee-for-service. CC is complication or comorbidity. MCC is major complication or comorbidity. SNF is Skilled Nursing Facilities.

Medicare FFS Readmissions Among Post-Acute Care Users, Alabama

30-day Readmission Rates for Top 20 Most Common MS-DRGs Discharged from Hospital to Selected Post-Acute Care (PAC) Settings, by Setting, 2014

MS-DRG Major joint replacement or reattachment of lower extremity w/o mcc Septicemia or severe sepsis w/o mv 96+ hours w mcc Heart failure & shock w mcc Heart failure & shock w cc Hip & femur procedures except major joint w cc Kidney & urinary tract infections w/o mcc Intracranial hemorrhage or cerebral infarction w cc or tpa in 24 hrs Renal failure w cc Septicemia or severe sepsis w/o mv 96+ hours w/o mcc Simple pneumonia & pleurisy w mcc Simple pneumonia & pleurisy w cc Cellulitis w/o mcc Renal failure w mcc Chronic obstructive pulmonary disease w mcc Pulmonary edema & respiratory failure Kidney & urinary tract infections w mcc Misc. disorders of nutrition, metabolism, fluids/electrolytes w/o mcc Esophagitis, gastroent & misc. digest disorders w/o mcc Intracranial hemorrhage or cerebral infarction w mcc G.I. Hemorrhage w cc

% of Home Health Users Readmitted

Within 30 Days 4.56% 20.98% 25.39% 23.57% 7.81% 17.27% 9.74% 21.60% 19.15% 17.74% 18.32% 13.62% 19.01% 21.74% 18.02% 19.19% 27.43% 17.28% 16.07% 17.28%

% of SNF Users Readmitted Within

30 Days 7.18% 23.52% 24.81% 19.75% 11.55% 12.67% 15.48% 23.59% 15.24% 26.46% 18.09% 18.55% 23.16% 23.00% 26.04% 18.35% 15.11% 12.18% 22.19% 15.00%

Source: Avalere Health, analysis of Medicare Standard Analytic Files, 2014

*Analysis includes Medicare Part A claims only.

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Note: FFS is fee-for-service. CC is complication or comorbidity. MCC is major complication or comorbidity. SNF is Skilled Nursing Facilities.

Medicare FFS Readmissions Among Post-Acute Care Users, Arkansas

30-day Readmission Rates for Top 20 Most Common MS-DRGs Discharged from Hospital to Selected Post-Acute Care (PAC) Settings, by Setting, 2014

MS-DRG Major joint replacement or reattachment of lower extremity w/o mcc Septicemia or severe sepsis w/o mv 96+ hours w mcc Heart failure & shock w mcc Heart failure & shock w cc Hip & femur procedures except major joint w cc Kidney & urinary tract infections w/o mcc Intracranial hemorrhage or cerebral infarction w cc or tpa in 24 hrs Renal failure w cc Septicemia or severe sepsis w/o mv 96+ hours w/o mcc Simple pneumonia & pleurisy w mcc Simple pneumonia & pleurisy w cc Cellulitis w/o mcc Renal failure w mcc Chronic obstructive pulmonary disease w mcc Pulmonary edema & respiratory failure Kidney & urinary tract infections w mcc Misc. disorders of nutrition, metabolism, fluids/electrolytes w/o mcc Esophagitis, gastroent & misc. digest disorders w/o mcc Intracranial hemorrhage or cerebral infarction w mcc G.I. Hemorrhage w cc

% of Home Health Users Readmitted

Within 30 Days 3.93% 20.28% 32.47% 23.96% 7.50% 19.39% 10.53% 26.73% 18.80% 21.17% 11.61% 14.39% 27.69% 24.44% 23.76% 18.33% 32.84% 23.46% 14.29% 25.00%

% of SNF Users Readmitted Within

30 Days 8.75% 22.80% 31.69% 29.70% 12.59% 15.89% 14.55% 22.92% 16.79% 22.30% 21.50% 10.00% 22.81% 22.22% 34.78% 20.17% 17.74% 19.59% 25.45% 20.00%

Source: Avalere Health, analysis of Medicare Standard Analytic Files, 2014

*Analysis includes Medicare Part A claims only.

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Note: FFS is fee-for-service. CC is complication or comorbidity. MCC is major complication or comorbidity. SNF is Skilled Nursing Facilities.

Medicare FFS Readmissions Among Post-Acute Care Users, Arizona

30-day Readmission Rates for Top 20 Most Common MS-DRGs Discharged from Hospital to Selected Post-Acute Care (PAC) Settings, by Setting, 2014

MS-DRG Major joint replacement or reattachment of lower extremity w/o mcc Septicemia or severe sepsis w/o mv 96+ hours w mcc Heart failure & shock w mcc Heart failure & shock w cc Hip & femur procedures except major joint w cc Kidney & urinary tract infections w/o mcc Intracranial hemorrhage or cerebral infarction w cc or tpa in 24 hrs Renal failure w cc Septicemia or severe sepsis w/o mv 96+ hours w/o mcc Simple pneumonia & pleurisy w mcc Simple pneumonia & pleurisy w cc Cellulitis w/o mcc Renal failure w mcc Chronic obstructive pulmonary disease w mcc Pulmonary edema & respiratory failure Kidney & urinary tract infections w mcc Misc. disorders of nutrition, metabolism, fluids/electrolytes w/o mcc Esophagitis, gastroent & misc. digest disorders w/o mcc Intracranial hemorrhage or cerebral infarction w mcc G.I. Hemorrhage w cc

% of Home Health Users Readmitted

Within 30 Days 3.33% 19.36% 28.83% 21.82% 10.91% 15.45% 13.16% 17.82% 14.89% 17.33% 18.03% 8.33% 24.66% 17.73% 17.43% 23.08% 20.78% 24.00% 19.23% 13.41%

% of SNF Users Readmitted Within

30 Days 7.45% 20.43% 24.77% 20.83% 9.26% 12.03% 20.00% 20.38% 15.15% 23.01% 18.99% 10.28% 24.29% 21.62% 19.74% 15.10% 15.38% 13.39% 23.19% 13.79%

Source: Avalere Health, analysis of Medicare Standard Analytic Files, 2014

*Analysis includes Medicare Part A claims only.

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Note: FFS is fee-for-service. CC is complication or comorbidity. MCC is major complication or comorbidity. SNF is Skilled Nursing Facilities.

Medicare FFS Readmissions Among Post-Acute Care Users, California

30-day Readmission Rates for Top 20 Most Common MS-DRGs Discharged from Hospital to Selected Post-Acute Care (PAC) Settings, by Setting, 2014

MS-DRG Major joint replacement or reattachment of lower extremity w/o mcc Septicemia or severe sepsis w/o mv 96+ hours w mcc Heart failure & shock w mcc Heart failure & shock w cc Hip & femur procedures except major joint w cc Kidney & urinary tract infections w/o mcc Intracranial hemorrhage or cerebral infarction w cc or tpa in 24 hrs Renal failure w cc Septicemia or severe sepsis w/o mv 96+ hours w/o mcc Simple pneumonia & pleurisy w mcc Simple pneumonia & pleurisy w cc Cellulitis w/o mcc Renal failure w mcc Chronic obstructive pulmonary disease w mcc Pulmonary edema & respiratory failure Kidney & urinary tract infections w mcc Misc. disorders of nutrition, metabolism, fluids/electrolytes w/o mcc Esophagitis, gastroent & misc. digest disorders w/o mcc Intracranial hemorrhage or cerebral infarction w mcc G.I. Hemorrhage w cc

% of Home Health Users Readmitted

Within 30 Days 3.02% 20.82% 24.51% 20.71% 4.18% 15.93% 13.38% 19.01% 15.78% 18.43% 14.40% 12.80% 25.00% 19.97% 23.20% 20.15% 19.43% 18.93% 18.93% 16.70%

% of SNF Users Readmitted Within

30 Days 6.53% 22.47% 25.27% 22.30% 10.48% 12.83% 13.13% 18.50% 16.63% 21.64% 16.08% 10.97% 24.32% 21.18% 23.89% 14.87% 14.45% 16.31% 20.58% 16.91%

Source: Avalere Health, analysis of Medicare Standard Analytic Files, 2014

*Analysis includes Medicare Part A claims only.

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Note: FFS is fee-for-service. CC is complication or comorbidity. MCC is major complication or comorbidity. SNF is Skilled Nursing Facilities.

Medicare FFS Readmissions Among Post-Acute Care Users, Colorado

30-day Readmission Rates for Top 20 Most Common MS-DRGs Discharged from Hospital to Selected Post-Acute Care (PAC) Settings, by Setting, 2014

MS-DRG Major joint replacement or reattachment of lower extremity w/o mcc Septicemia or severe sepsis w/o mv 96+ hours w mcc Heart failure & shock w mcc Heart failure & shock w cc Hip & femur procedures except major joint w cc Kidney & urinary tract infections w/o mcc Intracranial hemorrhage or cerebral infarction w cc or tpa in 24 hrs Renal failure w cc Septicemia or severe sepsis w/o mv 96+ hours w/o mcc Simple pneumonia & pleurisy w mcc Simple pneumonia & pleurisy w cc Cellulitis w/o mcc Renal failure w mcc Chronic obstructive pulmonary disease w mcc Pulmonary edema & respiratory failure Kidney & urinary tract infections w mcc Misc. disorders of nutrition, metabolism, fluids/electrolytes w/o mcc Esophagitis, gastroent & misc. digest disorders w/o mcc Intracranial hemorrhage or cerebral infarction w mcc G.I. Hemorrhage w cc

% of Home Health Users Readmitted

Within 30 Days 3.68% 13.99% 20.75% 22.66% 12.50% 16.67% 8.70% 10.00% 5.06% 17.80% 14.29% 10.26% 25.93% 16.92% 26.67% 16.67% 18.42% 16.39% 12.50% 16.67%

% of SNF Users Readmitted Within

30 Days 5.31% 18.58% 18.26% 16.08% 8.30% 9.24% 10.16% 12.50% 15.23% 15.94% 16.33% 6.59% 14.12% 13.13% 18.75% 12.71% 13.16% 11.30% 14.18% 14.81%

Source: Avalere Health, analysis of Medicare Standard Analytic Files, 2014

*Analysis includes Medicare Part A claims only.

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Note: FFS is fee-for-service. CC is complication or comorbidity. MCC is major complication or comorbidity. SNF is Skilled Nursing Facilities.

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