Readmissions in Massachusetts

The Center for Health Information and Analysis (CHIA) last week issued its latest report on all-payer, hospital-wide adult readmissions in Massachusetts, showing that the unplanned readmission rate for Massachusetts acute care hospitals in 2018 was 15.4% – unchanged from the previous year. 
CHIA’s analysis found that frequently hospitalized patients (those hospitalized four or more times in the previous 12 months) made up 6% of the overall patient population, but accounted for 52% of all readmissions. The top patient diagnoses for readmissions were heart failure, sepsis, and COPD.
In its second Behavioral Health Readmissions report released in October 2019, CHIA found that 45% of adults hospitalized in Massachusetts acute care hospitals had at least one co-morbid behavioral health condition, and the readmission rate for patients with any behavioral health co-morbidity was nearly double the readmission rate for patients without a co-occurring behavioral health condition.
In FY2019, MassHealth introduced a new 30-day readmission policy that addresses readmissions deemed to be clinically related to prior admissions and preventable. Thus far, the number of readmissions determined to be preventable has been overwhelming low. Through the first seven months of the policy, only 5% of clinically related readmission cases were determined preventable; that amount represents a small fraction of total MassHealth inpatient discharges. An MHA analysis of the recent CHIA report found that it also includes “swing beds” in calculating readmission rates for some hospitals, unfairly skewing the results against those facilities.
Not noted in the report is the fact that Massachusetts hospitals, according to a 2019 report card from the Commonwealth Fund, score the best in the country for hospital 30-day mortality. That is, while readmission rates remain stagnant in the state, the likelihood of people dying in hospitals is lower in the commonwealth than in other states.