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Hospital readmission rates, costs high in dermatology

Dermatological hospital readmission rates have remained constant, leading researchers to suggest improvements in both outpatient management of skin diseases and inpatient care.

Researchers conducted a cross-sectional study of the Nationwide Readmissions Database from 2010 to 2014 for dermatologic diseases via ICD-9 codes. They identified 3,602,599 dermatologic hospitalizations, of which 337,714 (9.8%) were readmitted for any cause within 30 days, 115,164 (3.3%) were admitted for the same cause within 30 days and 282,320 (7.8%) were readmitted for the same cause within the calendar year.

After adjusting for inflation, the cost of all dermatology-related hospitalizations from 2010 to 2014 was $27.8 billion, while the cost of all calendar year same-cause readmissions was $2.54 billion.

The most common diagnosis for hospitalization was cellulitis, comprising 83.6% of all admissions related to dermatology conditions.

The highest 30-day all-cause readmission rates were due to mycosis fungoides (32%), Sezary syndrome (29%) and graft-versus-host disease (28%). The highest 30-day same-cause readmission rates were vascular hamartomas (21%), dermatomyositis (18%) and thrombotic microangiopathy (14%). The conditions the with highest calendar year same-cause readmission rates were dermatomyositis (31%), systemic lupus erythematosus (24%) and vascular hamartomas (23%).

Over the 5-year period, the highest calendar year same-cause readmission costs were cellulitis at $1.94 billion and systemic lupus erythematosus at $221 million. Systemic lupus erythematosus had a 29% decreasing trend in total cost from 2010 to 2014, the only disease to show such a decreasing trend. Additionally, the mean costs of single diseases fluctuated over the years, and researchers were unable to isolate a trend.

Older age and Medicare insurance were associated with all-cause readmissions. However, readmission for same skin disease was associated with middle age, perhaps due to an increased prevalence of chronic and autoimmune diseases in this age group. In addition, same-cause readmission was associated with Medicaid insurance. The researchers suggested this may be a consequence of the barriers to outpatient access and post-hospitalization follow-up.

The researchers encouraged the implementation of urgent care dermatology clinics to circumvent referral to the ER. In addition, same-day appointments for patients with flares in skin conditions, dermatology involvement at multidisciplinary clinics and the use of teledermatology for patients who are medically underserved may reduce readmissions and costs.

The total cost of all calendar year same-cause readmissions was $508 million per year. The cost of readmissions in cellulitis was $389 million per year, with no decrease expected, according to researchers.

“These high costs highlight the importance of investment in inpatient dermatology services and coordination between inpatient and outpatient dermatology care in an effort to reduce readmissions and save health care dollars,” Myron Zhang, MD, of the department of dermatology at Weill Cornell Medicine, and colleagues wrote. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.