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International Journal of Health Economics and Management

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26.09.2017 | Research Article

Reducing excess hospital readmissions: Does destination matter?

verfasst von: Min Chen

Erschienen in: International Journal of Health Economics and Management | Ausgabe 1/2018

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Abstract

Reducing excess hospital readmissions has become a high policy priority to lower health care spending and improve quality. The Affordable Care Act (ACA) penalizes hospitals with higher-than-expected readmission rates. This study tracks patient-level admissions and readmissions to Florida hospitals from 2006 to 2014 to examine whether the ACA has reduced readmission effectively. We compare not only the change in readmissions in targeted conditions to that in non-targeted conditions, but also changes in sites of readmission over time and differences in outcomes based on destination of readmission. We find that the drop in readmissions is largely owing to the decline in readmissions to the original hospital where they received operations or treatments (i.e., the index hospital). Patients readmitted into a different hospital experienced longer hospital stays. The results suggest that the reduction in readmission is likely achieved via both quality improvement and strategic admission behavior.

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The specific formulas to calculate the readmission adjustment factor can be found at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html.

According to CMS, the Hospital Readmissions Reduction Program calculations only include short-term acute care hospitals paid under the Inpatient Prospective Payment System (IPPS), and acute care hospitals in Maryland participating in the All-Payer Model.

American Hospital Directory. Hospital statistics by state is based on each hospital’s most recent Medicare cost report.

For instance, the total Medicare reimbursements per enrollee for fee-for-service patients enrolled in Medicare Parts A and B range from $9685 in Sarasota, FL to $13,596 in Miami, FL, both are hospital referral regions.

In Florida, the 30-day all-cause readmission rates for heart attack, heart failure and pneumonia in 2008 are 19.3, 21.3 and 16, respectively. The national counterparts are 18.7, 21.4 and 15.3, respectively. Please refer to the Dartmouth Atlas (http://www.dartmouthatlas.org/) for more data details.

The specific ICD-9-CM codes for acute myocardial infarction (excluding one-day stay) include: 410.00, 410.01, 410.10, 410.11, 410.20, 410.21, 410.30, 410.31, 410.40, 410.41, 410.50, 410.51, 410.60, 410.61, 410.70, 410.71, 410.80, 410.81, 410.90, and 410.91. Congestive heart failure (CMS definition) includes principal diagnosis code (ICD-9-CM) 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 428.0, 428.1, 428.20, 428.21, 428.22, 428.23, 428.30, 428.31, 428.32, 428.33, 428.40, 428.41, 428.42, 428.43, and 428.9. Pneumonia (CMS definition) includes principal diagnosis code (ICD-9-CM) 480.0, 480.1, 480.2, 480.3, 480.8, 480.9, 481, 482.0, 482.1, 482.2, 482.30, 482.31, 482.32, 482.39, 482.40, 482.41, 482.42, 482.49, 482.81, 482.82, 482.83, 482.84, 482.89, 482.9, 483.0, 483.1, 483.8, 485, 486, 487.0, and 488.11.

For instance, AMI’s 30-day readmission rates to index versus non-index hospitals are 13.01 and 4.31% in 2006; 11.27 and 5.89% in 2014. In 2006, readmissions to non-index hospitals accounted for 25% of the total 30-day readmissions; and its share increased to 34% in 2014. From 25 to 34%, it is a 38% increase.

For the latter, recent trends show a sharp increase in hospitals’ use of observation status when treating Medicare patients (Feng et al. 2012; Woolhandler and Himmelstein 2016).

Ashton, C. M., & Wray, N. P. (1996). A conceptual framework for the study of early readmission as an indicator of quality of care. Social Science & Medicine (1982), 43(11), 1533–41.CrossRef

Ashton, C. M., Del Junco, D. J., Souchek, J., Wray, N. P., & Mansyur, C. L. (1997). The association between the quality of inpatient care and early readmission: A meta-analysis of the evidence. Medical Care, 35(10), 1044–59.CrossRefPubMed

Berenson, R. A., Paulus, R. A., & Kalman, N. S. (2012). Medicare’s readmissions-reduction program—a positive alternative. The New England Journal of Medicine, 366(15), 1364–66. doi:10.1056/NEJMp1201268.CrossRefPubMed

Brennan, N. (2014). Findings from recent CMS research on medicare. https://kaiserhealthnews.files.wordpress.com/2014/10/brennan.pdf.

Brooke, B. S., Goodney, P. P., Kraiss, L. W., Gottlieb, D. J., Samore, M. H., & Finlayson, S. R. G. (2015). Readmission destination and risk of mortality after major surgery: An observational cohort study. The Lancet, 386(9996), 884–895.CrossRef

Carey, K., & Lin, M.-Y. (2015). Readmissions to New York hospitals fell for three target conditions from 2008 to 2012, consistent with medicare goals. Health Affairs, 34(6), 978–85. doi:10.1377/hlthaff.2014.1408.CrossRefPubMed

Chen, M., & Grabowski, D. C. (2016). Hospital readmissions reduction program: Intended and unintended consequences. Available at SSRN: https://ssrn.com/abstract=3035717.

Dimick, J. B., & Ryan, A. M. (2014). Methods for evaluating changes in health care policy: The difference-in-differences approach. JAMA, 312(22), 2401–2. doi:10.1001/jama.2014.16153.CrossRefPubMed

Feng, Z., Wright, B., & Mor, V. (2012). Sharp rise in medicare enrollees being held in hospitals for observation raises concerns about causes and consequences. Health Affairs, 31(6), 1251–59. doi:10.1377/hlthaff.2012.0129.CrossRefPubMedPubMedCentral

Gerhardt, G., Yemane, A., Hickman, P., Oelschlaeger, A., Rollins, E., & Brennan, N. (2013). Medicare readmission rates showed meaningful decline in 2012. Medicare & Medicaid Research Review, 3(2), E1–12. doi:10.5600/mmrr.003.02.b01.CrossRef

Gonzalez, A. A., Shih, T., Dimick, J. B., & Ghaferi, A. A. (2014). Using same-hospital readmission rates to estimate all-hospital readmission rates. Journal of the American College of Surgeons, 219(4), 656–63. doi:10.1016/j.jamcollsurg.2014.05.008.CrossRefPubMedPubMedCentral

Jencks, S. F., Williams, M. V., & Coleman, E. A. (2009). Rehospitalizations among patients in the medicare fee-for-service program. The New England Journal of Medicine, 360(14), 1418–28.CrossRefPubMed

Khan, A., Nakamura, M. M., Zaslavsky, A. M., Jang, J., Berry, J. G., Feng, J. Y., et al. (2015). Same-hospital readmission rates as a measure of pediatric quality of care. JAMA Pediatrics, 169(10), 905–12. doi:10.1001/jamapediatrics.2015.1129.CrossRefPubMedPubMedCentral

Kim, H., Hung, W. W., Paik, M. C., Ross, J. S., Zhao, Z., Kim, G.-S., et al. (2015). Predictors and outcomes of unplanned readmission to a different hospital. International Journal for Quality in Health Care, 27(6), 512–18. doi:10.1093/intqhc/mzv082.CrossRefPubMedCentral

Kind, A. J. H., Bartels, C., Mell, M. W., Mullahy, J., & Smith, M. (2010). For-profit hospital status and rehospitalizations at different hospitals: An analysis of medicare data. Annals of Internal Medicine, 153(11), 718. doi:10.7326/0003-4819-153-11-201012070-00005.CrossRefPubMedPubMedCentral

Lu, N., Huang, K. C., & Johnson, J. A. (2016). Reducing excess readmissions: Promising effect of hospital readmissions reduction program in US hospitals. International Journal for Quality in Health Care, 28(1), 53–58.CrossRefPubMed

National Quality Forum. (2015). All-cause admissions and readmissions measures. Department of Health and Human Services. http://www.qualityforum.org/Publications/2015/04/All-Cause_Admissions_and_Readmissions_Measures_-_Final_Report.aspx.

Rau, J. (2012). Medicare To penalize 2217 hospitals for excess readmissions. Kaiser Health News. Aug 13. http://khn.org/news/medicare-hospitals-readmissions-penalties/.

Rau, J. (2013). Armed with bigger fines, medicare to punish 2225 hospitals for excess readmissions. Kaiser Health News. Aug 2. http://khn.org/news/readmission-penalties-medicare-hospitals-year-two/.

Rau, J. (2014). Medicare fines 2610 hospitals in third round of readmission penalties. Kaiser Health News. Oct 2.http://khn.org/news/medicare-readmissions-penalties-2015/.

Rau, J. (2016). Medicare’s readmission penalties hit new high. Kaiser Health News. Aug 2. http://khn.org/news/more-than-half-of-hospitals-to-be-penalized-for-excess-readmissions/.

Staples, J. A., Thiruchelvam, D., & Redelmeier, D. A. (2014). Site of hospital readmission and mortality: A population-based retrospective cohort study. CMAJ Open, 2(2), E77–85. doi:10.9778/cmajo.20130053.CrossRefPubMedPubMedCentral

Woolhandler, S., & Himmelstein, D. (2016). The hospital readmissions reduction program. http://www.nejm.org/doi/full/10.1056/NEJMc1606658?af=R&rss=currentIssue#t=article.

Zhang, D. J., Gurvich, I., Van Mieghem, J. A., Park, E., Young, R. S., & Williams, M. V. (2016). Hospital readmissions reduction program: An economic and operational analysis. Management Science Articles in Advance, 62, 3351–3371. doi:10.1287/mnsc.2015.2280.

Zuckerman, R. B., Sheingold, S. H., John Orav, E., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the hospital readmissions reduction program. New England Journal of Medicine, 374, 1543–1551. doi:10.1056/NEJMsa1513024.CrossRefPubMed

Titel: Reducing excess hospital readmissions: Does destination matter?
verfasst von: Min Chen
Publikationsdatum: 26.09.2017
Verlag: Springer US
Erschienen in: International Journal of Health Economics and Management / Ausgabe 1/2018
Print ISSN: 2199-9023
Elektronische ISSN: 2199-9031
DOI: https://doi.org/10.1007/s10754-017-9224-x

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Reducing excess hospital readmissions: Does destination matter?

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