A 7 minute read
March 27, 2019

Approximately 16 percent of discharged patients are readmitted to hospitals within 30 days. Roughly one-third of those patients are readmitted within just one week. Readmissions cost more than $41 billion every year, a cost which the Centers for Medicare and Medicaid Services (CMS) is trying to address with its Hospital Readmission Reduction Program, which saved more than $2 billion in 2018 alone.

The HRRP began in 2012, and fined hospitals with 30-day readmission rates that were higher than expected for heart failure, pneumonia, and myocardial infarction (heart attack). While the HRRP primarily targets principal heart failure admissions, where heart failure is the number-one cause of hospital admission, new research shows that readmissions also declined for patients who received a secondary diagnosis of heart failure.

Top 10 Hospitals with the Highest Heart Failure Readmissions Rates

Rank Hospital Name Heart Failure Readmission Rate Heart Failure Mortality Rate Staffed Beds
1.   Harlan ARH Hospital (KY)  29.8%  13.0% 73 
2.   Brooklyn Hospital Center at Downtown Campus (NY)  29.4%  11.5% 287 
3.   NYC Health and Hospitals - Harlem (NY)  28.4%  11.8% 229 
4.   Baptist Easley Hospital (SC)   28.4%    11.7%  89 
5.   Tug Valley ARH Regional Medical Center (KY)  28.1%    11.2%  88 
6.   East Orange General Hospital (NJ)   27.6%    9.0% 159 
7.   NYC Health and Hospitals - Kings County (NY)  27.4%   10.9% 406 
8.   Saint Annes Hospital (MA)  27.3%   10.1% 147 
9.   St Rose Hospital (CA)  27.3%   11.7% 195 
10.   Saline Memorial Hospital (AR)  27.2%    15.8% 130 

Fig 1 Readmissions rate data from Definitive Healthcare’s hospitals and IDNs platform. Veterans Affairs (VA) and Department of Defense (DoD) hospitals were excluded from this list.

Research from Rutgers University found there is one consistent red flag when it comes to 30-day readmissions: hospital performance scores. The study found that, in low-scoring hospitals, three percent of heart attack patients were readmitted for a second heart attack within 30 days. After one year, 13 percent of these patients were readmitted, with about eight percent dying from cardiovascular-related illness. Patients also faced higher risks for a second heart attack and higher mortality rates if they were also being treated for conditions like acute heart failure, high blood pressure, or chronic obstructive pulmonary disease.

In addition to influencing patient outcomes, hospital quality scores also impact patients’ decision-making. The Rutgers study found that 97 percent of patients would choose hospitals with higher quality scores, regardless of cost.

Hospital type also plays a role in patient readmissions. Patients admitted to a teaching hospital had a 25 percent lower chance of readmission within one month and had a mortality risk 10 percent lower than patients initially admitted to a non-teaching hospital.

Top 10 Hospitals with Most Heart Attack Diagnoses by Volume

Rank Hospital Name Heart Attack Diagnoses Heart Attack Readmissions Ratio Staffed Beds
1.   Morristown Medical Center (NJ) 120  0.92  606
2.   Spectrum Health Butterworth Hospital (MI) 93  1.01  1,078
3.   Memorial Medical Center (IL)  53   0.92  410
4.   Regional Medical Center of San Jose (CA)  50   1.19  258
5.   Sunrise Hospital & Medical Center (NV)  47   1.04  557
6.   UH Cleveland Medical Center (OH)  42    1.09   599
7.   St Josephs Hospital (FL)  38   0.94  527
8.   Community Medical Center (NJ)  34   1.00  424
9.   TriPoint Medical Center (OH)  33   1.14  312
10.   HonorHealth John C Lincoln Medical Center (AZ)  30   0.99  262

Fig 2 Diagnosis data from Definitive Healthcare’s Commercial Claims platform using full-year data from 2017. Excess readmission ratios are aggregate numbers from the 7/1/2014 through 6/30/17 collecting period.

As seen in the table above, the volume of heart attack diagnoses does not necessarily correlate with readmissions. Of the ten hospitals with the greatest number of inpatient heart attack diagnoses in 2017, two are in the 92nd percentile (99 is best) and four are in the top 50 percent. Three of the hospitals are in the lowest 10 percent for readmissions performance. According to Definitive Healthcare's Commercial Claims platform, inpatient heart attack diagnoses accounted for more than $12 million in charges in 2017, with an average cost of more than $18,000 per claim.

Earlier this month, a former graduate student from the Rochester Institute of Technology announced the pending FDA approval of a toilet seat that could detect heart failure in high-risk patients. A device embedded in the seat is capable of performing clinical-grade testing for systolic and diastolic blood pressure, blood oxygen levels, and heart stroke volume -- though the latter is only available through the use of more invasive procedures such as cardiac MRIs or catheterization. The creator of the device claims that, unlike wearable devices, the seat does not require charging and is already embedded in the daily habits of patients, making it a reliable source of patient data.

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