Study: Medicare patient death rates shortly after ER discharge raise concerns about rural care quality

Hospitals with the lowest inpatient admission rates for Medicare patients, many of which are located in rural areas, also had the highest rates of unexpected or early death in that patient population, according to a new study.

The research, which was published in The BMJ, raises concern about the resources available at rural hospitals and the impact of federal regulations that pressure hospitals of all kinds to reduce readmission rates on patient care quality, according to the authors.

“There’s no doubt there’s a lot of unnecessary hospital admissions, but this study suggests there’s also avoidable harm from sending people home that shouldn’t go home,” Ziad Obermeyer, M.D., a professor at Harvard Medical School and the study’s lead author, told STAT.

RELATED: Mortality rates soar as critical access hospitals perform more inpatient surgeries

The study team examined data on care provided to about 16 million Medicare beneficiaries between 2007 and 2012, focusing mostly on healthy patients and excluding records for patients with life-threatening illnesses or who were in nursing homes. The researchers found that about 0.12% of discharged patients died within 7 days. This amounted to about 10,000 unexpected deaths per year.

Hospitals with low admission rates, which discharged about 85% of patients, had a death rate 3.4 times higher than those with the highest admission rates, which discharged about 44% of patients. The illness of patients is unlikely to impact the results, Obermeyer told STAT, as hospitals with higher admission rates typically see sicker patients. This means that there is something in those low admission hospitals that is driving the results, he said.

Hospitals are under significant pressure from the federal government to reduce costly, unneeded admissions under the Affordable Care Act, and many rural hospitals or smaller facilities are already in dire financial straits. Staffing problems and technological issues can also be factors in admissions, according to the researchers.

The study also took a look at opioid abuse. One of the leading causes of unexpected death among the study population was narcotics overdose. Almost a third of Medicare beneficiaries were prescribed an opioid, including commonly-abused medications like Oxycontin and fentanyl, in 2015.

Dependence rates have also been on the rise among privately-insured patients.