The characteristics of the patients a hospital serves play a huge role in determining the readmission fines, according to a study.
Hospital readmission rates are based largely on the demographics and characteristics of the patients they serve, according to a study published in JAMA Internal Medicine.
It is not uncommon for Medicare to penalize hospitals with high readmission rates by up to 3% of the annual inpatient payments. However, the characteristics of the patients the hospitals serve play a huge role in determining the readmission fines, according to the findings.
The researchers used survey data from the Health and Retirement Study (HRS) to link Medicare claims for patients hospitalized from 2009 to 2012. Based on a total of 8067 admissions, they arrived at 29 patient characteristics used to determine the readmission rates for a 30-day period. The basis of their comparison was between hospitals with higher readmission rates versus hospitals with lower rates as reported by Medicare.
Based on the findings, it was revealed that hospital readmission rates are largely driven by a comprehensive set of patient characteristics.
Understanding of patient characteristics
Previous research in 2014 had found that hospitals were disproportionately fined under the program. A fine of $428 million was collected from 2610 hospitals for excess readmissions. The disproportionate fines arose from the fact that CMS had adjusted only for limited characteristics during a 12-month period before admission. The clinical and social characteristics were completely ignored while taking hospitalization and rehospitalization rates.
The characteristics of the patients now range from clinical to social, according to the study. The administrative and survey data assessed on a wide variety of factors such as demographic, clinical, social or financial. So while age, sex, or ethnicity is obviously taken into account, factors such as labor force status, household income, and Medicaid are also equally important.
Based on the findings of the HRS surveys, the study finalized on 24 variables that are essentially important in predicting readmission rates. For instance, the smoking status is highly influential in setting a readmission prediction. Patients who had never smoked had a readmission rate of 14.2% as against patients who have smoked in the past had 16.1% readmission rate. Patients who were currently smoking had a readmission rate of 17.1%. Such characteristics helped determine the differences in hospital readmission rates.
Other variables included race and ethnicity, education, labor force status, household income and assets, supplemental and prescription drug coverage, alcohol consumption, general health status, physical functioning, difficulties with activities of daily living, work limitations due to health, depressive symptoms and measures of household structure and social supports.
The study findings largely propose that the readmission rates differ from hospital to hospital. However, the hospital readmission rates are not solely indicative of the care patients receive from the hospital staff and services. The rehospitalization rates are also largely determined by patients’ demographic and clinical characteristics.