Non-Medicare Patients Account for Almost Half of 30-Day Readmissions

A new study finds that psychiatric disease and substance abuse are the top reasons for short-term rehospitalizations among non-Medicare patients. 

A newly released analysis by researchers at Beth Israel Deaconess Medical Center shows that, when the rates, characteristics, and costs of hospital readmissions across all ages and insurance types are compared, non-Medicare patients account for nearly half of all 30-day readmissions. Psychiatric disease and substance abuse were the most common diagnoses associated with readmission among patients ages 18 to 64. Medicaid patients had very high rates of short-term readmissions across all age groups.

“As rehospitalization costs continue to rise, efforts to reduce hospital readmission rates have become a national health care priority,” says Robert Yeh, MD, MSc, MBA, senior author of the analysis and director of the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at BIDMC in a news release. “With this analysis, we determined the specific causes of and the cost burdens associated with readmissions for patients of all ages and insurance coverage. We found there is tremendous potential to reduce readmissions by delivering targeted interventions for specific conditions within high-risk groups.”

Readmissions’ High Costs

The researchers evaluated data from the Nationwide Readmissions Database for patients over 18 years old who were hospitalized for any condition and discharged between January 2013 and November 2013. The patients were divided into age groups—18 to 44, 45 to 65, and 65 and older, and the data included discharges at more than 2,000 hospitals in 21 states.

The analysis found that out of the more than 12.5 million discharges evaluated, approximately 1.8 million patients were readmitted within 30 days. Medicare patients accounted for 56% of all readmissions. The readmissions translated to total annual hospital costs of $50.7 billion – Medicare readmissions resulting in a cost of $29.6 billion and non-Medicare in a cost over $21 billion in 2013. 

 “Our findings show that while Medicare readmissions represent more than half of all hospital readmissions, non-Medicare readmissions are frequent and make up a significant percentage and substantial cost,” says first author Jordan Strom, MD, research fellow at the center for research in a news release.

“We found that readmission among the non-elderly was most often driven by psychiatric and substance abuse problems, compared to the most common reasons for readmission in the elderly, which included pneumonia, heart failure and heart attack,” Strom adds.

As changes to national healthcare legislation are proposed, particularly those regarding Medicaid funding, the costs and causes of hospital readmissions should be considered. 

“These findings clearly highlight the significant use of unplanned hospital-based care among younger patients, particularly among the Medicaid population,” Yeh says. “Therefore, any changes to Medicaid coverage will require alternative solutions to ensure that the current benefits can continue to be provided without creating financial catastrophe for these patients or the institutions that care for them.”