HHSC has published its Potentially Preventable Readmissions Public Reports for Hospitals – January 2011.
Key components of the summary of the report:
- H.B. 1218, 81st Legislature, Regular Session 2009, requires the Health and Human Services Commission (HHSC) to identify potentially preventable readmissions (PPRs) in the Medicaid population and report results confidentially to each hospital. The law also requires each hospital to distribute the information to its care providers.
- This is the first year that PPR analysis has been done.
- A second analysis, based on SFY 2010 data, will be published in early 2012.
- HHSC has taken a different approach from Medicare to calculating and reporting readmission rates of the Medicaid population.
- HHSC approach considers almost all medical conditions but defines a potentially preventable readmission only when a plausible clinical connection exists between the initial admission and the readmission.
- Overall, 3.6% of Medicaid inpatients in SFY 2009 had at least one PPR within 15 days of discharge. The cost to Medicaid of these PPRs was $104 million, or about 3.5% of total Medicaid payments to hospitals.
- In calculating PPR rates, the methodology tries to exclude readmissions that were planned or otherwise unavoidable.
- The wide variation in casemix-adjusted PPR rates—the hospitals with the highest rates have rates two to four times higher than the hospitals with the lowest rates—suggests that opportunities exist for hospitals to learn from each other. (Casemix refers to the clinical characteristics of the population being served by each individual hospital.)
- This analysis was performed for HHSC by the Texas Medicaid and Healthcare Partnership (TMHP). Statements and opinions are those of the authors and not necessarily those of the Texas Health and Human Services Commission.
To help hospitals understand this study, and to help HHSC make it more useful to hospitals, TMHP has scheduled in-person presentations in January 2011 in Dallas, Houston, Mission, San Antonio and Amarillo. For details, refer to Question 21 in Section 3 of the link above. HHSC is interested in improving methodology and making results more useful to hospitals. At any time, comments and suggestions on this topic are welcomed, and can be emailed to PPR.Report@tmhp.com.