Length of Inpatient Stays and Outcomes

For decades much of health policy regarding hospitals has been focused on reducing the length of inpatient stays, partly for cost savings, but also in a belief that this would improve outcomes.  A paper published by the National Bureau of Economic Research challenges that thinking.  (NBER Paper)   Other research has already suggested that shorter stays may be a contributing to readmissions, which the system is hellbent on eliminating.  The authors in this paper focus on readmission reduction as well, comparing outpatient and inpatient interventions.  They studied a variety of programs used to keep Medicare patients from coming back to the hospital once they were discharged, but the researchers also examined the impact of programs that increased patient length of stay before discharge.  They also compare MA and FFS beneficiaries on the theory that they two types of Medicare programs may provide different incentives to hospitals and may have a different focus on outpatient care management after discharge.

Looking at heart failure patients, they found that adding one hospital day to their stay appeared to decrease readmission risk  by 7%, but did not affect mortality rates.  A similar readmission effect was not found for heart attack or pneumonia patients.  But the extra day did reduce mortality for heart attack patients by 22% and for pneumonia ones by 7%, potentially saving over 20,000 lives a year.  Some of the authors’ reasoning is odd, particularly the assumptions underlying the comparison of MA and FFS beneficiaries, but there is a logic to believing that perhaps in some cases patients are discharged too quickly from hospitals, probably as a result of reimbursement methods that in essence penalize hospitals for longer stays.