Hospital performance not the driving force in readmissions

More than half of rehospitalizations due to location, community factors, study finds
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Though hospitals increasingly strive to reduce readmissions to comply with benchmarks set by value-based payment models, a new study suggests that many of the factors that cause higher readmission rates are location-related and therefore out of healthcare facilities' control.

The study, published in the Health Services Research journal, analyzed publicly reported 30-day readmission rates from 2007-2010 for patients with acute myocardial infarction, heart failure or pneumonia at more than 4,000 hospitals. Researchers then linked these figures to demographic data culled from resources such as the U.S. Census and the Neilsen PopFacts database.

What the study found was that location was crucial--researchers attributed 58 percent of the total variation in hospital 30-day readmission rates to the county where the hospital was located. In other words, individual hospital performance accounts for only 42 percent of the variation in readmission rates.

Areas with higher readmission rates tended to have larger percentages of the population who were eligible for Medicare, higher numbers of residents who had never married and "low employment designation," the study found.

While previous studies have chronicled the link between lower socioeconomic status and hospital readmissions, the most surprising finding, according to the study authors, is the higher rate of readmission in areas with large numbers of Medicaid beneficiaries. Since readmission rates were adjusted for age, and areas known as "retirement destinations" actually had lower rates of readmission, the disparity is likely caused by "an additional effect, perhaps related to health-system variables," they wrote.

One of the most crucial health-system variables that determines the rate of readmissions is the number of general practitioners in the community, primarily because patients in areas with fewer general practitioners have few options but to return to the hospital when they experience complications, the study notes. This factor, too, is related to location, as at least one report has indicated that doctor shortages are a region-specific issue.

Since factors like patients' socioeconomic status and health-system variables account for the majority of variation in readmission rates, "narrowly targeting hospitals with reimbursement adjustments and other incentives can lead at best to marginal improvements in readmission rates," the study concludes, adding that "more effective policies might be directed at the wider system of care, including primary care and nursing home quality." Indeed, the use of community-based approaches such as employing patient navigators has been found to cut down preventable readmissions.

Another recent outcome-based study echoed this sentiment, with researchers concluding that since many readmissions are due to common complications such as surgical-site infections, postoperative readmissions "may not be an appropriate measure for pay-for-performance programs but rather better suited as measure for hospitals to track internally," FierceHealthcare reported.

To learn more:
- check out the study

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