Hospital-Wide Adult All-Payer Readmissions and Revisits in Massachusetts

Readmissions

Hospital readmissions are a central issue in efforts to improve health care quality and reduce costs, due to readmissions being a costly and potentially preventable problem that impacts patient health and experience of care both nationally and in Massachusetts. CHIA currently releases three analytic products annually concerning readmissions:

• CHIA’s report on Hospital-Wide Adult All-Payer Readmissions in Massachusetts: SFY 2011-2021 presents statewide readmissions by patient characteristics and reason for initial hospitalization, readmission rates for COVID-19 and non-COVID-19 discharges, and readmission rates for individual hospitals and groups of hospitals. Additionally, this is the second report to incorporate social risk factors into the risk-standardization methodology for hospital readmission rates to provide a more equitable basis for comparing performance across Massachusetts hospitals. In October 2023, CHIA published its first report on pediatric readmissions which reports statewide rates for those aged 18 years and younger.

• Behavioral Health and Readmissions in Massachusetts Acute Care Hospitals is a statewide, all-payer examination of the prevalence of behavioral health comorbidities and readmissions among hospitalized adults in Massachusetts acute care hospitals. Given the high hospital utilization and cost associated with comorbid behavioral health conditions, stakeholders share a growing awareness that patients with behavioral health comorbidities may have a higher than average risk of readmissions, thus any efforts to reduce readmissions should include identifying risk factors associated with these populations.

• The Hospital Readmissions Profiles series offers a graphical report for each acute care hospital in the Commonwealth.  These profiles provide more in-depth readmission statistics for each hospital broken out by several factors and presented in the context of the statewide figures. In October 2023, CHIA published a new online dashboard along with Massachusetts hospital specific profiles.
  
  

Revisits

Providers, payers, and policymakers are increasingly turning their attention to whether the patient returns to the acute care setting at any level (emergency department (ED), observation, or inpatient) within 30 days of inpatient discharge.

Emergency Department Visits After Inpatient Discharge: SFY 2017, released in June 2019, analyzed emergency department (ED) revisits (defined as an ED visit within 30 days of a patient's inpatient discharge). This work expanded upon CHIA's readmissions research.

Accounting for Social Risk Factors in Public Reporting on Unplanned Hospital Readmissions in Massachusetts: A Workgroup Report

In February 2020, CHIA released a report from the statewide Social Risk Factors and Readmissions Workgroup, which details the proposed solution for accounting for social risk factors in the public reporting of all-payer, unplanned hospital readmissions.

In 2018 and 2019, CHIA convened a multi-stakeholder workgroup to consider whether CHIA should account for social risk factors in its analysis of hospital readmissions, and if so, to provide recommendations for doing so given the available data sources and methods.

CHIA has adopted a conceptual framework for social risk factors and expanded its existing risk-adjustment model to incorporate patient- and community-level social risk factors. This enhanced methodology is utilized in CHIA's March 2022 annual readmissions report.