Facts Related to Heart Failure Rehospitalizations

Below are some facts that can assist your agency’s collaborative efforts with hospitals in reducing readmissions. 
  • ClicktoPrint-button_square.pngRehosptializations Most Common DRGs Discharged from Hospital to Home Health within 30 Days (Medicare Part A claims)
    • Heart Failure & Shock with complication or comorbidity – 26.20%
    • Heart Failure & Shock with major complication or comorbidity  – 28.48%
  • Clinical Profile of Home Health Users – Primary ICD-9 Codes (Medicare Part A claims)
    • Diabetes mellitus – 9.71%
    • Care involving use of rehabilitation procedures – 6.89%
    • Essential hypertension – 6.87%
    • Other orthopedic  aftercare – 6.53%
    • Other and unspecified aftercare – 5.98%
    • Heart failure – 5.55%
Source: Avalere Health, LLC, analysis of Medicare Standard Analytic Files, 2011
Medicare’s Hospital Compare
30-day death and readmission measures for heart failure
  • The 30-day readmission measures are estimates of unplanned readmission for any cause to any acute care hospital within 30 days of discharge from a hospitalization. CMS chose to measure readmission within 30 days instead of over longer time periods (such as 90 days), because readmissions over longer periods may be impacted by factors outside hospitals’ control such as other complicating illnesses, patients’ own behavior, or care provided to patients after discharge.  
What patients are included?
  • The 30-day mortality and readmission measures include hospitalizations for Medicare beneficiaries aged 65 or older who were enrolled in Original Medicare (traditional fee-for-service Medicare) for the entire 12 months prior to their hospital admission (and for readmissions, for 30 days after their original admission). The AMI, heart failure, and pneumonia mortality and readmission measures also include patients aged 65 or older who were admitted to Veteran’s Health Administration (VA) hospitals. Beneficiaries enrolled in Medicare managed care plans are not included. The readmission measures do not include patients who died during the index admission, or who left the hospital against medical advice.
More information about the Hospital Compare data: http://www.medicare.gov/hospitalcompare/Data/30-day-measures.html
How to find out more details:
  • Go to Hospital Compare: http://www.medicare.gov/hospitalcompare/search.html
  • Type zip code
  • Select facilities
  • Readmissions, complications & deaths
    • States Better than U.S. National Rate
    • No Different than U.S. National Rate
    • Worse than U.S. National Rate
    • Click view More Details (above the Graphs) to see information in sample below