Why is our readmission rate increasing?

The three most common drivers of rising 30-day readmission rates are medication non-compliance after discharge (38% of cases), inadequate follow-up scheduling at discharge (27%), and premature discharge driven by length-of-stay pressure (19%). Generic BI tools show you the rate. They don't show you which discharge day of the week has the highest readmission correlation.

Readmission rates are rising across healthcare in 2025–2026 for reasons that are structurally interconnected. Each of the three primary drivers has a distinct mechanism that requires a different prevention strategy—and all three are measurable with existing EHR data.

Medication non-compliance (38% of cases) has two components: polypharmacy reconciliation failures and cost barriers. Patients discharged with 6+ medications face a 40% higher 30-day readmission rate than those discharged with fewer. The reconciliation failure typically occurs when the discharge medication list doesn't accurately reflect what the patient was taking before admission—leading to duplication, contraindications, or missed medications that destabilize chronic conditions within 7–14 days. The cost barrier is separate: patients who cannot afford their post-discharge prescriptions often don't fill them and don't report this to their provider until they return in crisis.

Inadequate follow-up scheduling (27% of cases) reflects a structural gap between inpatient and outpatient systems. When discharge coordinators schedule a follow-up appointment, they often schedule to the first available slot—which may be 14–21 days after discharge. CMS data shows that the 7-day follow-up appointment rate is the single strongest predictor of 30-day readmission prevention: patients with a primary care or specialist visit within 7 days of discharge have 28% lower readmission rates than those whose first follow-up is after 7 days.

Premature discharge (19% of cases) is driven by length-of-stay pressure from case management and payer authorization limits. When utilization review determines a patient no longer meets inpatient criteria, discharge occurs even when clinical staff assess the patient as not fully ready. These premature discharges are concentrated in specific DRGs—heart failure, COPD, pneumonia—where the readmission risk is highest and where HRRP penalties apply.

Standard readmission dashboards hide the weekend discharge effect—one of the most actionable and consistent predictors of readmission risk. Patients discharged Friday through Saturday have 24–31% higher 30-day readmission rates than those discharged Monday through Thursday. The mechanism is simple: pharmacy access is limited on weekends (many specialty pharmacies are closed), primary care follow-up scheduling is constrained (offices are closed, can't schedule until Monday), and transition support resources are reduced (social work, care management).

Aggregate readmission rates also hide condition-specific patterns. A hospital with an overall 17.8% 30-day readmission rate may have a 24% readmission rate for heart failure and a 12% rate for pneumonia. HRRP penalty calculations are condition-specific, which means the organization's financial exposure is concentrated in the high-readmission DRGs, not distributed proportionally across all patients. Without condition-level segmentation, improvement resources get distributed across all discharge patients rather than focused on the high-risk DRGs where penalty exposure is highest.

Add discharge day of week as a dimension in your readmission analysis. If Friday and Saturday discharges have significantly higher 30-day readmission rates than mid-week discharges, implement an enhanced discharge protocol for end-of-week discharges: pharmacist-confirmed prescription fill before leaving, next-business-day callback from care coordinator, and pre-scheduled Monday outpatient follow-up rather than relying on patient self-scheduling.

Implement a 7-day follow-up appointment rate tracking metric at the unit or service line level. The target is 85% of high-risk discharge patients with a scheduled and confirmed follow-up appointment within 7 days. High-risk patients can be identified using LACE score calculation from EHR data—patients scoring above 10 on LACE have a 25%+ readmission probability and should be prioritized for intensive transition support.

For medication reconciliation, implement a pharmacist-led discharge review for all patients with 6+ medications or any patient who experienced a medication change during the admission. Pharmacist-led discharge medication reconciliation has been shown in multiple studies to reduce medication-related readmissions by 18–24%. The HRRP penalty conditions—heart failure, AMI, pneumonia, COPD, hip and knee arthroplasty, and CABG—should all receive pharmacist discharge review as standard protocol, not as an exception.