Longer Hospital Stays May Mean Better Readmission Outcomes

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.