Poverty plagues readmissions, study finds, as providers face steep penalties
The rehospitalization rate for Medicare beneficiaries is as high as 27 percent among the nation’s poorest neighborhoods.
“Overall, patients from disadvantaged neighborhoods are at greater risk for rehospitalization regardless of their treating hospital.”
According to a new report, poverty continues to have an effect on repeated hospitalizations -- a situation that threatens to cost health systems in higher Medicare readmissions penalties if post-discharge plans are not established.
Among the nation’s poorest neighborhoods — in places like Dallas, Atlanta, Chicago, and Philadelphia — the rehospitalization rate for Medicare beneficiaries is as high as 27 percent, reports a new study in the Annals of Internal Medicine. University of Wisconsin medical professor Amy J.H. Kind, MD, and colleagues examined a national cohort of 5 percent of Medicare patients discharged after treatment for congestive heart failure, pneumonia or a heart attack between 2004 and 2009, mapping the patients’ hospitalization rates across zip codes ranked along a poverty index.
Among the least impoverished 85 percent of neighborhoods — middle class and wealthy city neighborhoods, suburbs and country tracts — the rehospitalization did not vary very much, hovering around 21 percent, Kind and colleagues found. But in the other 15 percent, the most poverty-stricken areas, rehospitalization rates were fairly higher, ranging from 22 percent to 27 percent, with the rates increasing along with the poverty index.
The most disadvantaged neighborhoods have a rehospitalization risk “similar to that of chronic pulmonary disease and greater than that of uncomplicated diabetes,” Kind said in the report. “Overall, patients from disadvantaged neighborhoods are at greater risk for rehospitalization regardless of their treating hospital.”
[See also: Big data tools tackle readmissions.]
Poverty-related disadvantages such as low incomes, limited education, crime and derelict housing “contribute to rehospitalization but are often overlooked when creating individual care plans post discharge,” and may also be overlooked in Medicare policy, the study concludes.
Rehospitalizations within 30 days of discharge affect 20 percent of Medicare patients, and consume $17 billion annually — one reason why Medicare is now penalizing hospitals for high rates of readmissions for cases of heart failure, pneumonia and heart attack.
The readmissions penalty policy suggests “that all hospitals can prevent at least some rehospitalizations by using a spectrum of programs to better support vulnerable patients during the high-risk period after hospital discharge,” Find said. “However, the targeting of these programs has proven challenging.”
While the particular impacts of poverty on Medicare beneficiaries is an ongoing area of research, the study adds to previous findings suggesting a significant impact on readmissions.
A recent study of Medicare patients treated at Henry Ford Hospital in Detroit in 2010 concluded that beneficiaries living in high-poverty neighborhoods were 24 percent more likely to be readmitted after accounting for demographics and clinical conditions.
"Whether hospitals should be held accountable for the effects of poverty, illiteracy, lack of proficiency in English or lack of social support in the patients and communities they serve has not yet been resolved,” said Jianhui Hu, an associate at Henry Ford’s Center for Health Policy and Health Services Research, and lead author of the study in Health Affairs.
“Our findings underscore the importance of reaching consensus on this issue and, if appropriate, changing the risk-adjustment models, related penalties or both.”
Until a resolution comes, Kind and colleagues from Wisconsin suggest that health systems can try to measure data on impoverished regions across their patient populations to tailor individual-and community-based initiatives that support patients after discharge — with home health visits, remote monitoring, community clinics and more.
Medicare, meanwhile, is going ahead with its readmissions penalties. This year it has fined a record number of hospitals — 2,610 — for rehospitalizations, with 39 hospitals receiving the largest penalty allowed, including teaching facilities serving high-risk, low-income patients in places like Philadelphia.
