Hospital readmission rate tied closely to overall hospital admissions

High hospital readmission rates among Medicare patients are closely tied to higher overall hospital admission rates, according to a study published last week in the New England Journal of Medicine.

The study, conducted by Arnold Epstein, MD, Ashish Jha, MD, and John Orav, PhD, at the Harvard School of Public Health, examined rehospitalization rates across the country for Medicare patients with congestive heart failure and pneumonia. It also looked at how other variables, such as overall hospitalization rates, differences in patients' coexisting conditions, quality of discharge planning, and the number of hospital beds and physicians, affected readmissions.

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“We found a substantial association between regional rates of rehospitalization and overall admission rates,” the researchers concluded. “Although most interventions designed to reduce readmissions thus far have focused on better disease management and the coordination of care, our results underscore the importance of policy efforts directed at reducing the general incentives to use hospital services.

“Programs that provide shared savings with an accountable clinical entity or that structure payment incentives so that they are closer to that of capitation may be more successful in reducing readmissions.”

Key findings of the research included:

• Rehospitalization rates for congestive heart failure varied by region, ranging from 11 percent to 32 percent, while readmission rates for pneumonia varied from 8 percent to 27 percent.
• Of all the potential causes for regional differences in readmission rates, overall hospital admission rates played the biggest role, accounting for 16 percent to 24 percent of the variation in cases of congestive heart failure and 11 percent to 20 percent for pneumonia cases. No other factor accounted for more than 6 percent of the variation.
• If all-cause admission rates of hospital referral regions in the upper quintile of hospital use were reduced to the rate of regions in the lowest quintile, the readmission rate for congestive heart failure would be reduced from 24.6 percent to 21.2 percent. For pneumonia, the study found the readmission rate would be reduced from 17.9 percent to 15.5 percent.
• Hospital referral regions with high readmission rates were more likely to have medium-sized or large hospitals and to be located in the Northeast.

The study used 2008 data from Medicare, the Dartmouth Atlas and the Hospital Consumer Assessment of Healthcare Providers and Systems to compare readmission rates among patients with congestive heart failure or pneumonia by hospital referral region to determine whether regional variation was attributable to a regional propensity to hospitalize patients, patients’ coexisting conditions, quality of discharge planning, physician supply or bed supply. The study looked at 306 referral regions that included more than 4,000 hospitals.