This Readmission Report is available from the Quality Menu and detailed reporting period data.  

Readmission rates are a common quality indicator and can be compared to national, state and local rates.

 

Hospitalizations account for nearly one-third of the total $2 trillion spent on health care in the United States. In the majority of cases, hospitalization is necessary and appropriate. However, a substantial fraction of all hospitalizations are patients returning to the hospital soon after their previous stay.   These readmissions are costly, potentially harmful, and often avoidable.

 

 

Target Audience for this Report

Quality and Utilization Departments, Leadership Team, Medical Director and Physician Relations.

 

Business Processes Impacted by this Report

The evaluation of concurrent review and discharge planning programs of both the health plan and the hospital are informed by this data and opportunities for improvement can be identified.  The rate of avoidable readmissions can be reduced by improving core discharge planning and transition processes out of the hospital.

 

Improving transitions and care coordination between care settings can be achieved through network development and collaboration with post-acute settings.  This data can be shared to monitor the outcomes.  Patient and families require education and support through care management and member outreach services to increase their understanding of discharge instructions and management of their illness.

 

Data this specific can be used for comparisons and education across facilities and PCP Groups to develop strategies using best practices and trends where appropriate.  This provides insight to discharge planning practices by facility and PCP Group.

 

Diagnosis specific readmission data is critical to understand the impact of Disease Management Programs provided by both the health plan and the PCP Groups.

 

Detail and Definitions

 

Trending Graphs

 

Period by Period – Readmission Rate (Hospital)

  • Percentage of Admissions that are Readmissions
  • Trend Period

 

Period Over Period Trend – Readmission Rate (Hospital)

  • Percentage of change from prior period.
  • Trend Period

 

Header

  • Same hospital has 3 indicators – All, Yes, and No to indicate if member was admitted to the same hospital of discharge or a different one.  Selecting “All” displays the entire dataset for the readmission to any hospital.
  • Readmissions
  • Readmit Rate
  • ALOS/Readmit
  • Potential Savings

 

Readmissions by Place of Service

  • Hospital
  • Place of Service
  • Readmits
  • Readmit Rate
  • Total Paid
  • Avg Risk
  • ALOS

 

Readmissions by PCP Group

  • PCP Group
  • Readmits
  • Readmit Rate
  • Total Paid
  • Avg Risk
  • ALOS
  • Savings Opp

 

Members with Readmissions

  • Member Number
  • Member Name
  • Readmits
  • Admits
  • Readmit Rate
  • Total Paid
  • Avg Risk

 

Readmissions by Diagnosis

  • Dx Code
  • Dx Description
  • Readmits
  • Days Interval