Invisible Returns: Mapping Fragmentation in Readmissions and ED Revisits through Payer Claims Data
Vizient, Inc. obtained certification from the Centers for Medicaid and Medicare Services (CMS) in 2022 to become a Qualified Entity (QE), allowing us to receive 100% of Medicare claims from all 50 states and the District of Columbia. As part of this certification, Vizient publishes an annual public report utilizing this data, in combination with other Vizient data resources, to provide metrics of healthcare utilization and quality.
The measures evaluated in this report include data from 2023 and examines 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 potential fragmentation in care delivery, a factor associated with persistently high readmissions and ED revisits, lower quality of care, and increased healthcare costs. The findings underscore the need for structural reforms within healthcare markets, especially in communities disproportionately burdened by health-related vulnerabilities. The data source is Vizient’s Qualified Entity (QE) dataset, which includes 100% of Medicare fee-for-service claims nationwide, alongside an all-payer dataset to provide a comprehensive view across patient populations.
The standard measures included is Hospital-Wide-All-Cause Unplanned Readmission Rate. The alternative measure included are the 30-day ED Revisit Rate and the Vizient Vulnerability Index (VVI). Prevalence measures included are the percentage of readmissions and ED revisits to a different hospital.
The findings reveal significant disparities in both readmission and ED revisit rates based on neighborhood vulnerability as measured by the Vizient Vulnerability Index (VVI), payer type, service line, market type (rural vs. urban) and market provider concentration. Patients residing in more vulnerable neighborhoods, particularly those covered by Medicaid and Medicare, are more likely to be readmitted or revisit the ED, and to do so at a different hospital. These patterns suggest higher fragmentation of care and reflect underlying barriers related to access, socioeconomic conditions, and system coordination. Behavioral health stands out as a service line with particularly high rates of readmissions and ED revisits to a different hospital, highlighting unique challenges in continuity of care. Regional variation also emerged, with southern states showing higher rates of hospital switching during readmissions. Urban versus rural trends and market concentration, quantified by the Herfindahl-Hirschman Index (HHI), are also associated with differences in care patterns. Rural markets as well as more fragmented markets with lower provider concentration tend to experience higher rates of hospital switching during readmissions and ED revisits, underscoring the role of structural healthcare access and integration challenges.
Contact qecpinfo@vizientinc.com for additional information, a deeper look into the data, or an analysis of your organization to improve healthcare delivery and patient outcomes.