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October 2019

Maryland’s Hospitals Reduce Admissions and Readmissions Faster Than the Nation

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Maryland’s hospitals are leading efforts to transform care across the state. They help individuals manage chronic conditions as outpatients and coordinate continuing care with skilled nursing facilities and other non-acute care providers. Importantly, hospitals also have successfully lowered the number of Medicare fee-for-service beneficiaries who die within 30 days of admission.

All statistics here refer to Medicare fee-for-service beneficiaries; Maryland has more than 950,000.

Maryland’s hospitals and health systems reduced inpatient admissions more than two times faster than the nation.

Reducing Medicare Inpatient Admissions

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SOURCE: MHA Analysis of Medicare FFS Claims, CMS Chronic Conditions Data Warehouse (CCW)

Despite patient complexity rising by 7.5%, hospitals reduced admissions and mortality rates

Decreasing Mortality

The percentage of Maryland beneficiaries who died within 30 days of admission declined twice as quickly as the nation.

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Dropping Readmissions

Since the inception of the Maryland Model in 2014, the state’s hospitals have cut readmissions for all payers. Readmission rates fell four times faster than the nation.

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SOURCE: MHA Analysis of Medicare FFS Claims, CMS Chronic Conditions Data Warehouse (CCW)

Looking Ahead: Unmet Needs

Higher readmission rates for subgroups reveal some needs are not being met.

To make the Maryland Model even more successful, hospitals now look to expand partnerships to support the health of people having complex medical or social needs. Vulnerable Medicare beneficiaries, such as those who are also eligible for Medicaid (dual eligibles) and people with primary or co-occurring mental health conditions, often need additional care and wrap-around supports not readily available to all.

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Opportunities with Complex Patients

Even though readmission rates are declining across Maryland, rates for people who experience mental health conditions and those who are dually eligible remain high.

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SOURCE: MHA Analysis of Medicare FFS Claims, CMS Chronic Conditions Data Warehouse (CCW). Dual-eligibility status was obtained from the MBSF – Base (A/B/C/D) and condition categories (Alzheimer’s/dementia and depression) were obtained from the MBSF - Chronic Conditions Segment

All sectors share responsibility for attacking the root causes:

  • Find new ways for payers, hospitals, doctors, state and local government, and community partners to work together to address the non-medical needs impacting patients’ health
  • Consider the unmet medical and social needs of subpopulations when measuring performance and setting targets

Definitions

Admissions, mortality, and readmissions are measures used to understand the quality of health care system, and how well populations are cared for within that system. In this issue of MHA Insight the following definitions are used for these measures:

  • Admissions: The number of patients admitted to a hospital, per 1,000 beneficiaries
  • Mortality: The number of patients admitted to a hospital who then die within 30 days of admission, per 1,000 beneficiaries
  • Readmissions: The number of patients who are re-admitted to a hospital within 30 days of discharge from a hospital, per 1,000 beneficiaries

Technical Notes

  • Admissions and readmissions are reported as rates per 1,000 Medicare fee-for-service (FFS) beneficiaries
  • Denominators include Maryland Part A or Part A+B beneficiaries, and were calculated from the Chronic Conditions Data Warehouse’s (CCW) Master Beneficiary Summary File (MBSF). Also known as the Medicare cohort file, MBSF base segment includes beneficiary demographics and enrollment information
  • Numerators for admission rates are for Maryland residents who met the selection criteria of the denominators, and were hospitalized at a short-stay acute-care hospital
  • Numerators for readmission rates are for Maryland Medicare FFS beneficiaries who were hospitalized at a short-stay acute-care hospital, and experienced an unplanned readmission for any cause within 30 days of discharge
  • Numerators for mortality rates are for Maryland Medicare FFS beneficiaries who were hospitalized at a short-stay acute-care hospital, and died from any cause within 30 days after the index admission date
  • Beneficiary characteristics, such as dual-eligibility and (end-stage renal disease) ESRD status, were obtained from the MBSF – Base (A/B/C/D)
  • Condition categories, such as Alzheimer’s/dementia and depression, were obtained from the MBSF - Chronic Conditions Segment*
  • Alzheimer's/Dementia: Beneficiaries with FFS coverage at any time during the year who received treatment for Alzheimer's disease or related senile dementia within a 3-year look back period
  • Depression: Beneficiaries with FFS coverage at any time during the year who received treatment for depression within a 1-year look back period

* Please refer to the CCW Chronic Condition Categories for more details on algorithm criteria.