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DataBrief Series ● March 2012 ● No. 28

Chronic Conditions and Rehospitalizations

In 2009, Medicare beneficiaries with 5 or more chronic conditions were more than twice as likely to be rehospitalized within 30 days as all other Medicare beneficiaries who were hospitalized?

• The rehospitalization of Medicare beneficiaries is a frequently occurring and significant problem.1

• Unplanned rehospitalizations can be dangerous and sometimes life-threatening. They are also costly; in 2004, the estimated cost of unplanned rehospitalizations was $17.4 billion.1

• In 2009, 38% of Medicare beneficiaries with 5 or more chronic conditions who were hospitalized during the year were rehospitalized within 30 days, as compared to 16% of all Medicare beneficiaries who were hospitalized during the year.2

• Similarly, rehospitalization rates at 60 and 90 days after an inpatient stay were significantly higher for beneficiaries with 5 or more chronic conditions compared to all Medicare beneficiaries who had an inpatient stay.2

Chronic Conditions and Rehospitalizations Among Seniors

Page 2DataBrief (2012) ● No. 28

1Jencks, Stephen, Mark Williams and Eric Coleman. “Rehospitalizations Among Patients in the Medicare Fee-For-Service Program.” New England Journal of Medicine 360 (2009): 1418-1428.2Avalere Health, LLC. Analysis of 2009 Medicare Standard Analytic Files. Excludes individuals who died in 2009.

Rehospitalization Rates Increase With Time, Especially for Medicare Beneficiaries With Multiple Chronic Conditions

DataBrief (2012) ● No. 28Page 3

1 N = 4,355,540 total Medicare beneficiaries with one or more inpatient stays, 372,800 total Medicare beneficiaries with 5+ chronic conditions and one or more inpatient stays.

All Medicare Beneficiaries¹ Medicare Beneficiaries with 5+ Chronic Conditions¹0%

10%

20%

30%

40%

50%

60%

16%

38%

20%

47%

23%

52%

Rehospitalization Rates for Medicare Beneficiaries With One or More Inpatient Stays, 2009

30-Day Rehospitalizations 60-Day Rehospitalizations 90-Day Rehospitalizations

About the data:

Analytics powered by Avalere Health LLC

A Clear Policy ConnectionRehospitalizations are potentially dangerous events for Medicare beneficiaries and are very costly to Medicare. Though some rehospitalizations are unavoidable, others could be prevented by improving communication between patients and providers, reducing medication errors, and improving coordination between hospitals, post-acute, and long-term care providers.1 This is particularly critical for individuals with chronic conditions.

The Affordable Care Act (ACA) includes provisions to address rehsopitalizations as a means to improve care quality and reduce costs. One such provision will impose progressive reductions in Medicare payments to hospitals with high 30-day rehospitalization rates beginning in October 2012.1 Another ACA provision established the Community-Based Care Transitions Program, which authorizes $500 million to test models for improving care transitions from hospitals to other settings and reducing readmissions for high-risk Medicare beneficiaries through partnerships between hospitals and community-based organizations. The program began in April 2011 and will run for five years. In November 2011, the Centers for Medicare and Medicaid Services announced the first seven sites selected for participation, representing communities in Georgia, Ohio, Maine, Arizona, New Hampshire, and Illinois.2

This analysis used 2009 Medicare claims data to identify individuals with chronic conditions, using a list of 21 common chronic conditions derived from the Medicare Chronic Condition Working file.

Individuals were defined as having a rehospitalization if they had one or more hospital admissions for any cause within 30 days, 60, or 90 days of a prior hospital admission. This analysis is limited to individuals enrolled in the fee-for service, or traditional, Medicare program, and excludes beneficiaries who died in 2009.

DataBrief (2012) ● No. 28Page 4

1Healthcare.gov. Roadmap to Better Care Transitions and Fewer Readmissions. Accessed December 8, 2011 at: http://www.healthcare.gov/compare/partnership-for-patients/safety/transitions.html. 2Centers for Medicare and Medicaid Services. Medicare Demonstrations: Details of the Community- Based Care Transitions Program. Accessed December 8, 2011 at: https://www.cms.gov/demoprojectsevalrpts/md/itemdetail.asp?itemid=CMS1239313.