Hospitals, like many providers, have to feel buffeted by inconsistent regulatory and purchaser demands. Payment systems for hospitals, particularly in Medicare, have changed so that they incent shorter hospital stays. And there are no extensive penalties for readmissions, which may partly be caused by discharging patients to soon. A new piece of research from the National Bureau of Economic Research adds further fuel to the fire by suggesting that longer stays sometimes lead to fewer readmissions and lower mortality. (NBER Study) The study examines data from 2008 to 2011. Because length of stay seems to vary depending on day of the week of admission (hospitals apparently want to discharge patients before a weekend), the researchers were able to use that as a natural tool to ascertain differences in readmission and mortality. Medicare began its readmission reduction program because as many as 20% of inpatient stays were followed by a readmission in 30 days. A large number of care coordination, discharge and outpatient interventions have been developed to lower the risk of readmission. The authors test whether it might be as or more effective to simply keep patients a day longer in the hospital. The result varied by condition. For heart failure, an extra day’s stay was equally effective as outpatient interventions, decreasing readmission risk by 7%. For heart attack and pneumonia, however, the additional day in the hospital was not significantly linked to fewer readmissions but reduced mortality risk by 22% for pneumonia patients and 7% for heart attack ones. They also found that readmission rates were lower for Medicare Advantage enrollees than for patients in fee-for-service Medicare. There are many problems with CMS’ readmission penalty program, and one appears to be that its payment mechanism encourages earlier discharges than may be advisable to limit readmissions and mortality.
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
It may be investors that need the redesign. They just keep pouring money into this digital health crap despite all the losses. Redesign Health claims that it makes money by...
September 16, 2022
In truth, this seems like more money down a rathole. Google’s parent and other investors are putting a billion dollars into Google’s health arm, Verily. Apparently want to compete with...
September 12, 2022
It is like investors have learned nothing from the past two years. Even supposedly smart investors like Morgan Health, which is making a $20 million contribution to LetsGetChecked, which supposedly...
September 12, 2022
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace