By Megan Mulligan on July 16, 2010 10:45 AM

I recently received a question from one of our members asking: “Is there a standard percentage goal rate for hospitals to decrease their readmission rate? For instance, should our goal be to decrease our readmission rate by 2% or 30%?” This is an excellent question–and one that I’m sure many of you are wondering as well–so I wanted to share my thoughts.

First: There is No Standard Percent Goal Rate for Hospitals to Decrease Readmission Rates

I want to say upfront, that there is no standard percentage goal rate for hospitals to decrease their readmissions for a couple of reasons. First, all hospitals would have to be starting from the same (or at least similar) readmission rate, which we know is not the case. Obviously, hospitals with very high readmission rates have more room for improvement, while hospitals with lower readmission rates have less room for improvement.

In addition, each hospital has MANY factors that could potentially make their readmissions reductions goals different. The first is patient and market characteristics, including:

• Case mix index
• Volume
• Payer mix
• Geographic location

The second is organizational factors, including:

• Resources available
• Executive support
• Staff buy-in
• Alignment with physicians

It is certainly plausible that hospitals with greater resources to dedicate to readmissions projects can be more aggressive in the annual reductions they expect to achieve.

Recommendations for Setting Your Own Hospital’s Goals

However, I am by no means saying that there is not a method for determining what your annual goal for decreasing readmission rates should be. Hospitals can, and should, set reasonable targets for decreasing their readmission rates from year to year. Here is some advice on how to go about setting your own percentage goal rate for readmissions.

1. Set a baseline rate: If you have been tracking readmission rates in a consistent fashion for a long period, then I would first determine what the year-to-year changes have been historically. That way, you have an understanding of what the typical variation is on a yearly basis.
2. Agree on a consistent definition: It’s also important to note that there are several different ways to track readmission rates (as shown in the chart below), so I would make sure that what you intend to track is consistent. For example, will you be tracking all-cause 30-day readmissions that occur hospital-wide? Or will you be narrowing the definition to 30-day readmissions for heart failure (HF) patients readmitted for HF?
3. Set a Realistic, but Ambitious Goal: Once a consistent definition for readmission is established, and a consistent methodology for tracking this data is implemented, you can begin to think about setting an improvement target relative to your current baseline. There are a few different ways of thinking about this:

• Attainable improvement rates – This would be picking an arbitrary, but low number that you think is reasonable to achieve in a given year, but that is statistically significant enough to account for regular fluctuations (as I mentioned earlier). These goals could also be called “conservative” or “realistic.”
• “Stretch Goals” - This category of achievement would be an ambitious target that would require more immediate and aggressive decreases in readmission rates. The benefit to this type of goal is that it really pushes the organization beyond what they thought possible; however, failing to meet the stretch goal could also cause feelings of defeat among staff.
• Comparison to control group - Rather than setting a goal for decreasing overall readmission rates, another option is to compare readmission rates for a particular patient population pre- and post-intervention. For example, if you are targeting heart failure patients, it may make sense to compare readmission rates within this population before and after implementing initiatives to reduce readmissions.

Comparing Annual Decreases in Readmission Rates within the Clinical Advisory Board Cohort:

To provide some basis for comparison, here are examples of annual decreases in readmission rates for hospitals that the Clinical Advisory Board has spoken with. Hospital names are blinded to protect their identity and shield confidential data.

(see original article)

I want to point out how different the decreases are–ranging from 2% to 47%. This is attributed to the definition being used AND whether they were only tracking readmission for a certain patient population (such as heart failure or COPD patients). Hence, the importance of following the steps outlined above. You’ll notice that the greatest decrease (of nearly 47%) was achieved because the hospital was focusing on a narrow population–COPD–and only tracking readmissions for COPD. Clearly, all-cause readmission rates will be much more difficult to inflect.

For more information on reducing readmissions, please register for one of our two remaining national meetings or register for an upcoming webconference this summer.