A new study conducted by Premier, Inc. and published in the Journal for Healthcare Quality suggests women and Medicare patients are more likely to be readmitted to a hospital. It also found that COPD and heart failure are among the top five disease states driving readmissions.
It evaluated readmission rates from approximately 15 million inpatient, all-payer discharges across more than 600 diverse hospitals. The study found that factors such as income, gender, age and payer status all showed a strong statistical significance in predicting readmissions within 30 days. Specifically, it suggests that the odds for heart attack patients being readmitted were:
- 17% higher for women than men.
- 24% higher for Medicare patients versus those with commercial insurance.
In addition, the lower the income and older an individual, the more likely they were to be readmitted. These findings suggest that readmission rates are closely linked to a patient's socioeconomic status.
The enactment of the Affordable Care Act led to reduced payments for hospitals with readmission rates exceeding an expected level. However, the Centers for Medicaid & Medicare Services's (CMS's) readmission penalty policy does not account for the major socioeconomic factors this research demonstrates are contributing to readmissions.
"There are many factors that affect hospital readmissions, but this research further brings to light that socioeconomic status is at least part of the equation. Failure to adjust for socioeconomic factors undermines today's value-based payment programs by disproportionately penalizing hospitals that serve large populations of low-income and minority patients. Particularly when we think about payment programs and safety net hospitals that are essentially doing more with less, we believe CMS should begin risk-adjusting for socioeconomic factors to avoid unfairly penalizing these providers. Despite operating with very low margins, these hospitals have put in place initiatives in their communities and outside the hospital to prevent readmissions and improve health," said Blair Childs, senior vice president of Public Affairs, Premier.
A separate Premier analysis of federal FY 2015 readmissions program results on the association of the readmission reductions on hospital cohorts found that disproportionate share hospitals (DSH) hospitals are less likely to avoid a readmissions penalty than non-DSH hospitals. The analysis controlled for other hospital characteristics, including teaching status, urban location, and size of facility.
Premier's study in the Journal for Healthcare Quality also identified the top five disease states driving risk adjusted readmission rates:
- Heart failure (20%)
- Chronic obstructive pulmonary disease (18%)
- Renal failure (17%)
- Sepsis (17%)
- Pneumonia (12%)
Furthermore, chronic and comorbid conditions were significant predictors for a readmission. Heart attack patients with diabetes or renal failure had a 42% higher chance of readmission. Discharge status also plays a key role, with heart attack patients discharged to a nursing home having a 43% higher chance of a readmission when compared to those that are sent home.
"In addition to factors that essentially have nothing to do with the quality of care provided, this research highlights areas providers should be paying extra attention to and demonstrates that meaningful risk-adjusted readmission rates can be tracked in a dynamic database. Efforts focused on targeted practices to prevent readmissions and adjust payment penalties for these vulnerable patient populations are essential," said John Martin, Premier vice president, research operations, and one of the study's authors.