Medicaid Admissions And Readmissions: Understanding The Prevalence, Payment, And Most Common Diagnoses

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VOL. 33| NO. 8August 2014Variety Issue

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Medicaid Admissions And Readmissions: Understanding The Prevalence, Payment, And Most Common Diagnoses

1. Tara Trudnak1,*, 
2. David Kelley2, 
3. Judy Zerzan3, 
4. Katherine Griffith4,
5. H. Joanna Jiang5 and 
6. Gerry L. Fairbrother6

+Author Affiliations

1. ¹Tara Trudnak (tara.trudnak@altarum.org) was a senior research manager at AcademyHealth at the time of this study and is currently a senior researcher at the Altarum Institute, in Alexandria, Virginia.
2. ²David Kelley is chief medical officer of the Pennsylvania Department of Public Welfare, in Harrisburg.
3. ³Judy Zerzan is chief medical officer and director of the Client and Clinical Care Office, Colorado Department of Health Care Policy and Financing, in Denver.
4. ⁴Katherine Griffith is a senior manager at AcademyHealth, in Washington, D.C.
5. ⁵H. Joanna Jiang is a senior social scientist in the Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, in Rockville, Maryland.
6. ⁶Gerry L. Fairbrother is a senior scholar at AcademyHealth.

1. ↵*Corresponding author

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.

• Hospitals
 
• Medicaid
 
• Mental Health/Substance Abuse
 
• Readmissions