Vizient report links readmission rates to local market dynamics, highlighting care fragmentation

IRVING, Texas, August 27, 2025—Vizient® today released a report identifying the impact of social determinants of health and local market dynamics on hospital readmission rates and emergency department (ED) revisits, with particular attention to whether patients return to a different hospital. This distinction is critical, as it highlights fragmentation in care delivery, a factor associated with persistently high readmissions and ED revisits, lower quality of care and increased healthcare costs. Read Invisible Returns: Mapping Fragmentation in Readmissions and ED Revisits through Payer Claims Data.

“The data show a significant portion of hospital readmissions and ED revisits are occurring at a different hospital than the original (index) site of care and at a higher cost compared to the original hospital,” said Madeline McDowell MD, senior principal, intelligence, Vizient. “These ‘invisible returns’ limit hospital visibility into the patient's post-discharge journey, complicating care coordination and outcome tracking as well as affecting penalties under the Hospital Readmissions Reduction Program administered by CMS.”

Drawing on 2023 data, from 100% of Medicare fee-for-service (FFS) claims data nationwide, combined with an all-payer dataset and the Vizient Vulnerability Index, the report features the following insights:

Over a quarter of hospital readmissions are "invisible" to original hospitals

More than 25% of hospital readmissions occur at a different hospital, meaning the original hospital has no visibility into what happened to their patient. This creates a blind spot in care coordination that could be driving up healthcare costs and compromising patient outcomes.

Switching hospitals is costly to patients and hospitals

Readmissions to a different hospital are five times more expensive than those readmitted to same hospital with an average excess of $1,372 per readmission, and an aggregate additional cost of $21 billion annually.

Emergency department revisits among patients that went to a different ED facility averaged 6.4% ($87) higher costs than those that went to the same ED facility. Cost increases were significantly higher for head injury and hypertension revisits to a different ED, averaging 29% ($400) and 12% ($198) higher costs.

Vulnerable communities face double jeopardy in healthcare access

Patients in the most vulnerable neighborhoods are not only more likely to be readmitted or revisit the emergency department, they're also significantly more likely to receive that care at a different hospital. From least to most vulnerable areas, readmissions to different hospitals increased by 78%, highlighting how social determinants create care fragmentation.

Behavioral health, neurosciences, and orthopedics show alarming care fragmentation

Over half of the readmissions in these three specialties occur at different hospitals, suggesting major gaps in follow-up care coordination. This is particularly concerning for behavioral health patients who may need consistent therapeutic relationships.

Geographic differences in readmissions and ED revisits were pronounced

Urban patients have higher overall readmission rates than rural patients (16.7% vs. 15.4%), but rural patients are more likely to be readmitted to a different hospital (35.1% vs. 32.3%). For ED revisits, the trend reverses: rural rates are higher (20.1% vs. 18.5%), while urban patients are less likely to revisit a different hospital. Regional disparities were also striking—Southwestern states such as Nevada, Texas, Oklahoma, and New Mexico showed some of the highest rates of patients switching hospitals for both readmissions and ED revisits, suggesting systemic healthcare fragmentation that may warrant policy intervention.

Hospital consolidation and competition within a market

In urban markets with multiple hospital systems, patients are more likely to be readmitted at a different hospital system than where they originally received care. By contrast, in markets with fewer systems—where hospitals are more consolidated—readmissions are less likely to occur outside the original system. This suggests that greater market fragmentation may contribute to care discontinuity.

“The findings of this report emphasize the importance of contextualizing hospital readmission and ED revisit measures within broader social and market dynamics. They highlight the need for hospitals to have a better understanding of what the drivers of readmissions are within their market. With the right information hospitals and health systems can apply the right solutions, such as regionalizing care and integrating electronic health records across sites and systems to address fragmentation, or using social vulnerability risk assessments to provide tailored interventions to high-risk populations,” said McDowell.

The Vizient report was written as part of the Medicare Data Sharing for Performance Measurement Program, also known as the CMS Qualified Entity Program. It represents 100% of Medicare FFS claims data nationwide, combined with Vizient proprietary all-payer claims dataset and the Vizient Vulnerability Index and provides a comprehensive view across patient populations.

Learn more about Vizient's work as a CMS Qualified Entity.

About Vizient, Inc.
Vizient, Inc., the nation’s largest provider-driven healthcare performance improvement company, provides solutions and services to more than two-thirds of the nation’s acute care providers and more than one-third of ambulatory providers. Vizient offers proprietary data and analytics to deliver unique clinical and operational insights and a contract portfolio representing $156 billion in annual purchasing volume enabling the delivery of cost-effective care. With its acquisition of Kaufman Hall in 2024, Vizient expanded its advisory services to help providers achieve financial, clinical and operational excellence. Headquartered in Irving, Texas, Vizient has offices throughout the United States. Learn more at www.vizientinc.com.