Irving-based Vizient® has released a new report, Invisible Returns: Mapping Fragmentation in Readmissions and ED Revisits through Payer Claims Data, revealing the costly impact of patients being readmitted or returning to the emergency department (ED) at a hospital different from where they first received care.
The analysis, based on 2023 Medicare fee-for-service claims, all-payer data, and the Vizient Vulnerability Index, shows that more than 25% of hospital readmissions occur at a different facility—leaving the original hospital with no visibility into the patient’s outcome.
“These ‘invisible returns’ limit hospital visibility into the patient’s post-discharge journey, complicating care coordination and tracking,” said Dr. Madeline McDowell, senior principal of intelligence at Vizient. “They also drive up healthcare costs and affect penalties under the Hospital Readmissions Reduction Program.”
Key findings include:
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High cost of switching hospitals: Readmissions to a different hospital are five times more expensive than same-hospital readmissions, with an average excess of $1,372 per patient and an aggregate additional cost of $21 billion annually.
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Emergency visits costlier at different hospitals: ED revisits at different facilities averaged 6.4% higher costs, with head injury revisits costing 29% more and hypertension 12% more.
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Vulnerable communities hit hardest: Patients in high-vulnerability neighborhoods are significantly more likely to be readmitted to different hospitals, with rates 78% higher than in less vulnerable areas.
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Specialties most affected: Behavioral health, neurosciences, and orthopedics showed the highest rates of fragmented care, with over half of readmissions occurring at different hospitals.
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Geographic disparities: Southwestern states, including Texas, Oklahoma, and New Mexico, had some of the highest rates of fragmented readmissions and ED revisits.
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Market structure matters: In urban areas with multiple hospital systems, patients are more likely to be readmitted at a different facility, while in more consolidated markets, continuity of care is stronger.
Vizient noted the findings emphasize the need for regionalized care strategies, expanded electronic health record integration across systems, and targeted interventions for vulnerable populations.
“This data underscores how both social determinants of health and market fragmentation affect patient outcomes,” McDowell said. “Hospitals need a clearer view of readmission drivers in their markets to apply the right solutions.”
