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. Readmissions are estimated to cost the healthcare system more than $20 billion a year.
The U.S. healthcare industry is more often tying reimbursement rates to the quality of patient care. For example, the Centers for Medicare and Medicaid Services (CMS) tracks readmission rates through the Hospital Readmissions Reduction Program (HRRP) as well as Diagnostic Related Groups (DRGs), which are used to categorize patients based on their primary diagnosis, procedures received, and discharge status. DRGs ensure that Medicare reimbursements take into account the types and level of severity of patients typically seen at the hospital.
For this Healthcare Insight, we use data from the Definitive Healthcare HospitalView product to analyze the top DRGs at hospitals with the highest readmission rates.
First, we gathered the top DRG codes for more than 4,800 hospitals.
Next, we analyzed the all-cause readmission rates from about 4,300 hospitals. This number is slightly lower because some hospitals, such as critical access hospitals and psychiatric hospitals, don’t track readmissions with CMS due to their specialties. The national average readmission rate is 15.0% with a range of scores from 9.9% to 22.5%.
Then we filtered out the hospitals with the highest all-cause readmission rate, those above 16%.
Finally, we compared the lists to find the top DRG codes at the hospitals with some of the highest readmission rates. This list shows the percentage of the 423 hospitals with the highest all-cause readmission rate that reported the DRG in calendar year 2021.
Top DRGs at hospitals with the highest readmission rates
|Rank||DRG code||Description||Percent of highest readmission rate hospitals||Explore dataset|
|1||871||SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC||74.2%||Explore|
|2||177||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC||68.6%||Explore|
|3||291||HEART FAILURE & SHOCK W MCC||68.3%||Explore|
|4||207||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96 OR MORE HOURS||64.5%||Explore|
|5||853||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC||64.5%||Explore|
|6||870||SEPTICEMIA OR SEVERE SEPSIS W MV 96 OR MORE HOURS||62.2%||Explore|
|7||208||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <96 HOURS||59.6%||Explore|
|8||4||TRACH W MV 96 OR MORE HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.||54.6%||Explore|
|9||193||SIMPLE PNEUMONIA & PLEURISY W MCC||53.7%||Explore|
|10||392||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC||53.7%||Explore|
|11||682||RENAL FAILURE W MCC||50.4%||Explore|
|12||280||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC||50.1%||Explore|
|13||329||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC||48.5%||Explore|
|14||65||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC||46.6%||Explore|
|15||872||SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC||45.6%||Explore|
|16||377||G.I. HEMORRHAGE W MCC||45.4%||Explore|
|17||64||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC||45.2%||Explore|
|18||246||PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4 OR MORE VESSELS/STENTS||44.4%||Explore|
|19||981||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC||44.4%||Explore|
|20||247||PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC||44.2%||Explore|
The top DRG codes at hospitals with the highest readmission rates are sepsis, respiratory conditions, including those with ventilator support, heart failure, and infectious and parasitic diseases.
Sepsis is the result of a complication of an infection and can be life-threating. It is a healthcare associate infection (HAI) where early detection and treatment is necessary.
The appearance of respiratory conditions on list is likely associated with chronic conditions, such as COPD, as well as COVID-19.
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.