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ABSTRACT Reducing hospital readmissions is a way to improve care and reduce avoidable costs. However, there have been few studies of readmissions in the Medicaid population. We sought to characterize acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. We found that Medicaid readmissions were both prevalent (9.4 percent of all admissions) and costly ($77 million per state) and that they represented 12.5 percent of Medicaid payments for all hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. The most prevalent diagnostic categories were mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications, which together accounted for 31.2 percent of readmissions. This analysis, conducted through the Medicaid Medical Directors Learning Network, allows Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement.
Because of their prevalence and cost, hospital readmissions repre- senta keypolicyissue for Medicaid medical directors, the clinical lead- ers of state Medicaid programs.1,2 National data show that about one in twelve adults discharged from a hospital was readmit- ted within thirty days, adding an additional $16 billion annually to health care costs in the United States.3
Patients may be readmitted to the hospital for a variety of reasons. However, research shows that a large number of repeat hospitalizations,1 as well as hospital admissions in general, may be avoidable.2 Thus, reducing preventable hospital- izations and readmissions is a key strategy for improving health, the quality of health care, and containing costs.
Medicaid has the largest number of beneficia- ries among all payers in the United States, with a reported sixty-two million beneficiaries in 2013.4 The Medicaid population will grow even larger with the coverage expansions under the Afford- able Care Act. The effects of costly utilization patterns, such as hospital admissions and re- admissions, for this large and growing popula- tion assume heightened importance under health reform.
Hospital readmissions for the Medicaid popu- lation have not been well studied.5 In contrast, there have been many studies of readmission rates for Medicare patients.1,6-12
The need to better understand Medicaid re- admissions was made...