Top 20 DRGs by Highest Readmission Rates

One of the biggest priorities in hospital care today is identifying the risks of and avoiding preventable readmissions. In 2011, readmissions cost the healthcare system $41.3 billion according to one estimate, a figure that has almost certainly increased in recent years. CMS keeps track of readmission rates for all diagnosis-related groups (DRGs), which define the total reimbursement a hospital receives for any episode of care.  The following list contains the top 20 DRGs by the highest Medicare patient readmission rate with at least 1,000 claims in 2015, excluding chemotherapy, lymphoma, and leukemia, which have uniquely high readmission rates. While they may not include the DRGs with the greatest overall admission costs by volume, they represent the conditions that may experience the highest rate decrease due to a focused readmission prevention effort.

The majority of the top 20 DRGs involve surgical care, as indicated by “OR Proc” in many of their descriptions. Given the number of potential complications from surgery (infections, medical errors, improper healing or wound reopenings), it’s not surprising the procedures would have higher rates of readmission. There are a few exceptions. Peripheral nerve disorders or neuropathies are commonly associated with other health conditions such as diabetes, especially in elderly populations, and likely contribute to greater readmission rates. Liver conditions also ranked highly, often due to complications of cirrhosis, alcohol hepatitis, or encephalopathy due to loss of function.

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