title: The cost of hospital readmissions: evidence from the VA.
abstract: This paper is an examination of hospital 30-day readmission costs using data from 119 acute care hospitals operated by the U.S. Veterans Administration (VA) in fiscal year 2011. We applied a two-part model that linked readmission probability to readmission cost to obtain patient level estimates of expected readmission cost for VA patients overall, and for patients discharged for three prevalent conditions with relatively high readmission rates. Our focus was on the variable component of direct patient cost. Overall, managers could expect to save $2140 for the average 30-day readmission avoided. For heart attack, heart failure, and pneumonia patients, expected readmission cost estimates were $3432, $2488 and $2278. Patient risk of illness was the dominant driver of readmission cost in all cases. The VA experience has implications for private sector hospitals that treat a high proportion of chronically ill and/or low income patients, or that are contemplating adopting bundled payment mechanisms.
authors.affiliation: Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA. kcarey@bu.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Carey
authors.affiliation: Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.|VA Office of Productivity, Efficiency and Staffing, Boston University School of Public Health, 200 Springs Road, Bedford, MA, 01730, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Stefos
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003953:Diagnosis-Related Groups; D005260:Female; D006333:Heart Failure / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000191:economics; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000191:economics; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Cost; Hospital; Readmission; VA