Why Reducing Hospital Readmission Rates Is More Complicated Than It Sounds.

Do demographic factors such as income, race, gender and age influence whether or not a patient will be readmitted within 30 days of discharge from a hospital? According to an analysis published recently in the Journal of Healthcare Quality the answer is a rousing yes.

Since 2012, the CMS has imposed penalties upon medical facilities found to have excessive readmission rates, bringing this contentious topic to the forefront of national discussion for healthcare providers. The policy has created a reverse financial incentive to reduce avoidable hospital expenses - the goal being to improve healthcare quality so as to to reduce readmission rates within 30 days.

Critics argue this policy further exacerbates the intensity of hospital burdens that serve in areas of socio-economic disparity. Factors such as crime, poverty, and unstable housing directly contribute to insurmountable rates of chronic conditions such as stroke, cancer, hypertension, heart disease, and diabetes. These are the same conditions that are more likely to see a disproportionate rate of readmission within 30 days.

“If you're being penalized at a very high level for something that you can't fully control, it's not a fair comparison,” said Blair Childs, senior vice president of Public Affairs for Premier Inc., which conducted the study.

Study authors also noted that female patients who had been treated for heart attacks had a 17% higher risk than men readmittance within 30 days, and 30-day readmission among Medicare heart attack patients was 24% higher than patients with commercial insurance.

The authors of the study intend to shine light on the inequities of the current CMS policy and to help hospitals identify key patient factors that could drive readmissions. It is particularly essential for hospitals in areas with vulnerable patient populations to focus on efforts to prevent excessive hospital readmissions and adjust payment penalties.

Here are the top five conditions that carried the highest risks for 30-day admission:

1. Heart failure (20%)

2. Chronic obstructive pulmonary disease (18%)

3. Renal failure (17%)

4. Sepsis (17%)

5. Pneumonia (12%)

The study findings confirm that higher hospital readmission rates occur in lower-income communities, as compared to readmission rates in higher-income communities. Unsurprisingly, hospitals that serve in these lower-income communities are also more likely to be penalized by the CMS. Critics contend that this stunts the growth of already-struggling facilities to make the necessary investments needed to improve doctor-patient relationships and establish higher quality healthcare.

“This research highlights areas providers should be paying extra attention to and demonstrates that meaningful risk-adjusted readmission rates can be tracked in a dynamic database,” said study co-author John Martin, Premier's vice president of research operations.

Growing recognition of the impact that health disparities have on hospital quality metrics prompted this CMS interactive map that helps identify how community and ethnicity factors affect disparities among medicare beneficiaries. The CMS Innovation Center, announced in January plans to test specifically whether addressing the socio economic conditions affecting that affect patient health can improve the quality of care and lower healthcare costs by reducing hospital readmissions.

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