Impact of super-utilizers on the Hospital Readmissions Reduction Program (HRRP) using Emergency Department administrative data

Background: In recent years, hospital emergency departments (ED) have been increasingly burdened by “super-utilizers,” the small number of patients whose health care expenditures and claims are disproportionate to the general population. Because their health issues are not addressed early, comprehensively or through primary care, super-utilizers frequently overuse ED services, resulting in  repeated hospitalization. Since the implementation of the Hospital Readmission Reduction Program (HRRP) in 2012, there has been an increased focus on reducing the rates of readmissions, specifically for the conditions of acute myocardial infarction, heart failure and pneumonia. Methods: This study evaluates ED data from 2009 to 2011 from Memorial Medical Center in Springfield, IL.  Patients seeking treatment in the ED for acute myocardial infarction, heart failure and pneumonia (as classified by ICD-9-CM diagnosis codes) who had readmissions within 30 days of initial treatment were identified as HRRP patients. Patients presenting to the ED at a frequency disproportionate to the majority of the patient population were classified as super-utilizers. Logistic regression was used to identify characteristics that were associated with HRRP patients, including age, gender, race, insurance and super-utilizer status. Results: This study aims to identify whether super-utilizers comprise a significant portion of the HRRP population by evaluating the composition of the HRRP population at the Springfield, IL Memorial Medical Center. Conclusion: Understanding the influence super-utilizers have on patient composition could drive future policies and programs aimed at improving care and reducing readmissions, resulting in overall cost savings.