Hospital Readmissions in the Medicare Population

Anderson, Gerard F.; Steinberg, Earl P.

doi:10.1056/nejm198411223112105

Cited by 300 publications

(225 citation statements)

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“…Our analyses show that the mix of beneficiaries served at the hospitals affects readmission rates. For example, consistent with Anderson and Steinberg [14] , readmission rates increased by about 0.09 percentage points for each percentage point increase in the share of dual eligible Medicare patients. Similarly, the effect of average risk scores on readmission rates is significant and relatively large: One unit increase in average risk score (e.g., increase from 1 to 2) increases the readmission rate by about 4.9 percentage points.…”

Section: Descriptive Findingssupporting

confidence: 61%

“…Dual eligible beneficiaries (low income and disabled beneficiaries covered by both Medicare and Medicaid) have been found to have significantly higher readmission rates than those with only Medicare coverage [14] . Corrigan and Martin found that individuals covered by Medicare and Medicaid (compared to private insurers) are more likely to be readmitted within a year [15] .…”

Section: Introductionmentioning

confidence: 99%

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Hospital readmission rates in Medicare

Erdem

Fout

Korda³

et al. 2014

JHA

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Hospital readmissions are the focus of many recent efforts to improve quality and reduce spending under the Affordable Care Act (ACA). We examined variations in Medicare readmission rates by hospital characteristics (e.g., type, size, utilization) and Medicare patient mix (i.e., share of dual eligible beneficiaries, share of patients under 65 years of age, health status). Using 2010 data from 3,543 short-stay Medicare-certified hospitals, readmission rates were higher for hospitals that served a greater share of patients who were dual-eligible and less healthy; and larger hospitals and hospitals with higher occupancy rates even after controlling for patient mix.

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Section: Descriptive Findingssupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Hospital readmission rates in Medicare

Erdem

Fout

Korda³

et al. 2014

JHA

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“…Dranove 2002) have reported that hospitals, like most …nancially oriented entities, have an incentive to increase pro…ts when possible. For instance, Friedman and Pauly (1983) and Anderson and Steinberg (1984) have shown that hospitals exhibit a pro…t-maximizing response to changes in reimbursement terms. In the US, the diagnosis related group (DRG) for the diagnosis of the patient at the time of discharge determines the amount that the hospital is paid (Fed- (Friedman and Pauly 1983).…”

Section: Discussion and Future Researchmentioning

confidence: 99%

Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations

2009

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Much of prior work in the area of service operations management has assumed service rates to be exogenous to the level of load on the system. Using operational data from patient transport services and cardiothoracic surgery-two vastly different health-care delivery services-we show that the processing speed of service workers is influenced by the system load. We find that workers accelerate the service rate as load increases. In particular, a 10% increase in load reduces length of stay by two days for cardiothoracic surgery patients, whereas a 20% increase in the load for patient transporters reduces the transport time by 30 seconds. Moreover, we show that such acceleration may not be sustainable. Long periods of increased load (overwork) have the effect of decreasing the service rate. In cardiothoracic surgery, an increase in overwork by 1% increases length of stay by six hours. Consistent with prior studies in the medical literature, we also find that overwork is associated with a reduction in quality of care in cardiothoracic surgery-an increase in overwork by 10% is associated with an increase in likelihood of mortality by 2%. We also find that load is associated with an early discharge of patients, which is in turn correlated with a small increase in mortality rate. Abstract Much of prior work in the area of service operations management has assumed service rates to be exogenous to the level of load on the system. Using operational data from patient transport services and cardiothoracic surgery -two vastly di¤erent healthcare delivery services -we show that the processing speed of service workers is in ‡uenced by the system load. We …nd that workers accelerate the service rate as load increases. In particular, a 10% increase in load reduces length of stay by 2 days for cardiothoracic surgery patients, while a 20% increase in the load for patient transporters reduces the transport time by half a minute. Moreover, we show that such acceleration may not be sustainable. Long periods of increased load (overwork) have the e¤ect of decreasing the service rate. In cardiothoracic surgery, an increase in overwork by 1% increases length of stay by 6 hours. Consistent with prior studies in the medical literature, we also …nd that overwork is associated with a reduction in quality of care in cardiothoracic surgery -an increase in overwork by 10% is associated with an increase in likelihood of mortality by 2%. We also …nd that load is associated with an early discharge of patients, which is in turn correlated with a small increase in mortality rate.We are grateful to the cardiac anesthesiologists and executives at the teaching hospital where this study was conducted. We also thank the Management Science review team as well as Stefanos Zenios, Chris Lee, and Marcelo Olivares for their insightful and constructive comments on an earlier version of this paper. The authors can be reached at dkc@emory.edu and terwiesch@wharton.upenn.edu.

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“…A study from the US calculated that between 1974 and 1977, 24% of Medicare inpatient expenditure was spent on readmissions. 22 This was projected to be about $8 billion in 1984. Therefore even a small decrease in readmissions will result in substantial savings.…”

Section: Discussionmentioning

confidence: 99%

“…HOSPITAL READMISSION RATES have been increasing during the last 5 years in developed [1][2][3] as well as developing countries. 4 Major concerns of readmission are the cost to the health services, financial implications and emotional distress to patients and their families and perpetuating dependency behaviour among patients.…”

mentioning

confidence: 99%

A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital

McLean¹,

Mendis²,

Canalese³

2008

Aust. Health Review

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Objective: To examine the trend in unplanned readmissions (URs) to Dubbo Base Hospital (DBH) over the period 1996-2005 and assess possible correlations with basic demographic data. Results: URs increased over the study period, both as a total number and as a proportion of total admissions (from 4.7 to 5.4%), while average length of stay decreased from 5.3 to 4.4 days and available hospital beds decreased from 156 to 116. The proportion of URs for people aged 75 years has more than doubled over the same period. There were clear temporal variations in URs (greatest number occurring on Fridays and in late winter/early spring) and variations with age and gender (greatest number in young males; peaks for males in 0-10 and 71-80-year deciles and for females in 0-10, 21-30 and 71-80 year deciles). Fifty percent of URs occurred within 7 days of discharge. There was a statistically significant but small correlation between length of prior admission and time to readmission (Spearman correlation coefficient, 0.068; P < 0.01) although the time to readmission did not change over the study period. Chronic obstructive pulmonary disease (3.8%), complications of procedures (3.6%), heart failure and pneumonia (each 2.2%), angina (2.1%) and acute bronchiolitis (1.8%) were the top causes of URs. Conclusion: URs are becoming more frequent in DBH; analysis of associations and trends over time are the first step in determining targeted HOSPITAL READMISSION RATES have been increasing during the last 5 years in developed 1-3 as well as developing countries. 4 Major concerns of readmission are the cost to the health services, financial implications and emotional distress to patients and their families and perpetuating dependency behaviour among patients. Furthermore, a recent statement by the then Australian Government Minister for Health and Ageing suggests that a range of indicators including unplanned readmission rates are likely to be used to compare hospital performance into the future. 5 It has been reported that a lower quality of inpatient care increases the risk for unplanned early readmission in patients with heart failure, diabetes, or obstructive lung disease, 6 and a recent study concluded that adjusted rates of What is known about the topic? Hospital readmission rates have been reported to be rising but there is little published Australian data, and no comprehensive hospital studies. It has been suggested that unplanned readmission might relate to premature discharge and quality of care, and unplanned readmission rates have been proposed as a potential key performance indicator for comparisons between hospitals in Australia, as is already occurring overseas. What does this paper add?This paper confirms that the unplanned readmission rate to a major regional public hospital has risen over the last 10 years and that there is a small but significant negative correlation with prior length of stay. It highlights some key demographic factors that are associated with high rates of unplanned readmissions, and diseases which...

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Hospital Readmissions in the Medicare Population

Cited by 300 publications

References 0 publications

Hospital readmission rates in Medicare

Hospital readmission rates in Medicare

Impact of Workload on Service Time and Patient Safety: An Econometric Analysis of Hospital Operations

A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital

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