- Patient-level factors appeared to be the main determinant for increased readmission risk in a study of colorectal resections at minority-serving hospitals, according to a new study in the journal Surgery, suggesting hospitals have little control over whether their poor or minority patients will face complications and return.
- The findings contribute to the discussion whether current Medicare policy is unfairly penalizing hospitals with significant poor and minority populations when it comes to readmission rates.
- While legislation is currently pending to account for socio-economic factors in readmissions penalties, the issue is as-yet unsettled.
The implications are huge for hospitals given the money at stake. Medicare expects to withhold a record-high total of about $528 million – up from $420 million in 2015 – next year. That means more than half of all U.S. hospitals are going to be dinged for their rehospitalization rates for patients discharged from July 2012 through June 2015, according to the analysis from Kaiser Health News.
The implications are also huge for poor and minority populations, given that if things aren't balanced, the hospitals serving them may be forced to stop doing so to avoid unsustainable financial penalties.
Even with the questions around fairness, it is notable that safety-net hospitals, despite their potentially greater challenges in avoiding readmissions, managed to respond to the incentive and reduce their readmission rates even more than other hospitals between fiscal years 2013 and 2016, according to a recent study from Boston University and Boston Medical Center. Those researchers suggested the playing field could be leveled by evaluating safety-net hospitals against other safety-net hospitals.
The new study looked at 168,000 recipients of colorectal resections at 374 California hospitals from 2004 to 2011. It found the odds for 30-day, 90-day, and repeated readmissions after the procedures were 19%, 20%, and 38% more likely at minority-serving hospitals than non-minority-serving hospitals after controlling for other factors. Among the findings were that risk factors significantly associated with readmissions and inpatient mortality included Medicaid/Medicare primary insurance and emergent operation, and that low procedure volume had a strong association with higher odds for inpatient mortality.