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Reducing Hospital Readmission Rates Will Require Community-Focused Efforts

Authors question federal penalties

A hospital’s ability to reduce repeat patient visits may have less to do with its performance and more to do with the characteristics of the community in which it’s located, according to a study published in the February issue of Health Services Research.

The new findings may call into question the effectiveness of some federal penalties for hospitals with higher-than-expected readmission rates.

The study looked at 4,073 U.S. hospitals that publicly reported 30-day readmission rates for patients discharged with acute myocardial infarction, heart failure, or pneumonia from 2007 to 2010. The article suggests that 58% of the national variation in hospital readmission rates during those years was explained by the specific county in which the hospital was located. Local factors, particularly the supply of general practitioners, but also income and employment levels and nursing-home quality, explain nearly half of the county’s effect on readmission rates, the study finds.

“This is one of the most thorough looks, to date, at how hospital readmission rates are explained by community-level factors,” said lead author Jeph Herrin, PhD, a researcher at the Health Research & Educational Trust (HRET), an affiliate of the American Hospital Association. “There has been little examination of how such community factors might influence the readmission rates of hospitals in those communities.”

Recently, the Centers for Medicare and Medicaid Services implemented the Hospital Readmission Reduction Program with the aim of levying penalties for hospitals with higher-than-expected readmission rates for Medicare patients.

In response to the study, Teryl Nuckols, MD, director of General Internal Medicine at Cedars–Sinai Medical Center in Los Angeles, suggested that these penalties may be ineffective. Some hospitals may be experiencing higher-than-expected readmission rates for reasons beyond their control, Nuckols said in a commentary submitted to HSR.

“[It] starts to raise questions about whether hospitals in socioeconomically disadvantaged and underserved communities may have little control over readmission rates, and yet be disproportionately penalized by the policy,” Nuckols said.

One of the strongest correlations to readmission rates, according to the study, is a community’s access to primary care and high-quality nursing home care.

“A substantial amount of the variation in readmission rates is explained by local health-system characteristics related to primary care access and the quality of nursing homes,” the authors wrote. “These findings have significant implications on how health care leaders, payers, and policy makers should conceptualize the level of accountability for excess readmissions.”

Sources: HSR; February 2015; and HSR/HRET; January 29, 2015.

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