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Excess Readmission rates for Heart Failure and Pneumonia by Hospital Type

Viraj Brahmbhatt

Abstract


The improvement of quality care is a major goal for modern healthcare. Quality of care is often measured through readmission rates for specific conditions such as heart failure, pneumonia, total arthroplasty of the knee/hip, etc. This data has been used by the Center for Medicare and Medicaid Services (CMS) to adjust reimbursement rates for hospitals with excessive readmissions. Different hospital operations and management models possess structural differences that may impact the rates of readmission. This study investigated whether there were significant differences in the readmission rates for academic, non-profit, and for-profit hospitals. The results may be important in reshaping guidelines to assess hospitals based on readmission rates. The average excess readmissions for heart failure were in non-profit hospitals for 1.0047, for-profit hospitals for 1.013, and academic hospitals for 0.975. The ANOVA for this set returned a p-value of 1.70284E-05, meaning that the results were statistically significant. As such, academic hospitals have statistically lower readmission rates for heart failure. The excess readmission rates for pneumonia yielded 1.025 for non-profit, 1.024 for for-profit, and 0.99 for academic hospitals. The ANOVA returned a p-value of 2.4899E-09, which suggests the differences seen are statistically significant. As such, academic hospitals also have a statistically lower rate of pneumonia readmissions. The study has implications for consumer decision-making when choosing a hospital. In addition to this, algorithms for benchmarking as well as CMS adjustments to reimbursement rates may consider factoring in the hospital ownership type.

 

Doi: 10.28991/SciMedJ-2022-04-02-03

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Keywords


Quality Care; Readmissions; Heart Failure; Pneumonia; Data Analysis.

References


Devereaux, P. J., Choi, P. T. L., Lacchetti, C., Weaver, B., Schünemann, H. J., Haines, T., Lavis, J. N., Grant, B. J. B., Haslam, D. R. S., Bhandari, M., Sullivan, T., Cook, D. J., Walter, S. D., Meade, M., Khan, H., Bhatnagar, N., & Guyatt, G. H. (2002). A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ. Canadian Medical Association Journal, 166(11), 1399–1406.

Kruse, F. M., Stadhouders, N. W., Adang, E. M., Groenewoud, S., & Jeurissen, P. P. T. (2018). Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review. International Journal of Health Planning and Management, 33(2), e434–e453. doi:10.1002/hpm.2502.

U.S. Centers for Medicare & Medicaid Services. (2022). Quality Measurement and Quality Improvement. U.S. Centers for Medicare & Medicaid Services (CMS), Baltimore, United States. Available online: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement- (accessed on April 2022).

Brahmbhatt, V. V. (2022). Emergency department average wait time before admission, average time till sent home, and average number of violations for different hospitals types in Tennessee: Date analysis of Medicare data. MedRxiv. doi:10.1101/2022.12.12.22283361.

Lutfiyya, M. N., Bhat, D. K., Gandhi, S. R., Nguyen, C., Weidenbacher-Hoper, V. L., & Lipsky, M. S. (2007). A comparison of quality of care indicators in urban acute care hospitals and rural critical access hospitals in the United States. International Journal for Quality in Health Care, 19(3), 141–149. doi:10.1093/intqhc/mzm010.

Ayanian, J. Z., & Weissman, J. S. (2002). Teaching Hospitals and Quality of Care: A Review of the Literature. Milbank Quarterly, 80(3), 569–593. doi:10.1111/1468-0009.00023.

Hillmer, M. P., Wodchis, W. P., Gill, S. S., Anderson, G. M., & Rochon, P. A. (2005). Nursing home profit status and quality of care: Is there any evidence of an association? Medical Care Research and Review, 62(2), 139–166. doi:10.1177/1077558704273769.

Akintoye, E., Briasoulis, A., Orhurhu, V., Ibrahim, W., Kumar, K., Nas, H., & Weinberger, J. (2017). Impact of Hospital Ownership on in-Patient Mortality and Cost of Hospitalization in Patients Admitted for Heart Failure: Insight from the National Inpatient Sample (Nis). Journal of the American College of Cardiology, 69(11), 770. doi:10.1016/s0735-1097(17)34159-1.

Weiss, A. J., & Jiang, H. J. (2021). Overview of clinical conditions with frequent and costly hospital readmissions by payer, 2018. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality (US), Rockville, United States.

Weissman, J. S., Ayanian, J. Z., Chasan-Taber, S., Sherwood, M. J., Roth, C., & Epstein, A. M. (1999). Hospital Readmissions and Quality of Care. Medical Care, 37(5), 490–501. doi:10.1097/00005650-199905000-00008.

Van Walraven, C., Bennett, C., Jennings, A., Austin, P. C., & Forster, A. J. (2011). Proportion of hospital readmissions deemed avoidable: A systematic review. CMAJ. Canadian Medical Association Journal, 183(7). doi:10.1503/cmaj.101860.

Parina, R. P., Chang, D. C., Rose, J. A., & Talamini, M. A. (2015). Is a low readmission rate indicative of a good hospital? Journal of the American College of Surgeons, 220(2), 169–176. doi:10.1016/j.jamcollsurg.2014.10.020.

Kansagara, D., Englander, H., Salanitro, A., Kagen, D., Theobald, C., Freeman, M., & Kripalani, S. (2011). Risk Prediction Models for Hospital Readmission. JAMA, 306(15), 1688. doi:10.1001/jama.2011.1515.

Birmingham, L. E., & Oglesby, W. H. (2018). Readmission rates in not-for-profit vs. proprietary hospitals before and after the hospital readmission reduction program implementation. BMC Health Services Research, 18(1). doi:10.1186/s12913-018-2840-4.

Gupta, A., Allen, L. A., Bhatt, D. L., Cox, M., DeVore, A. D., Heidenreich, P. A., Hernandez, A. F., Peterson, E. D., Matsouaka, R. A., Yancy, C. W., & Fonarow, G. C. (2018). Association of the hospital readmissions reduction program implementation with readmission and mortality outcomesin heart failure. JAMA Cardiology, 3(1), 44–53. doi:10.1001/jamacardio.2017.4265.

Ferro, E. G., Secemsky, E. A., Wadhera, R. K., Choi, E., Strom, J. B., Wasfy, J. H., Wang, Y., Shen, C., & Yeh, R. W. (2019). Patient readmission rates for all insurance types after implementation of the hospital readmissions reduction program. Health Affairs, 38(4), 585–593. doi:10.1377/hlthaff.2018.05412.

Zuckerman, R. B., Sheingold, S. H., Orav, E. J., Ruhter, J., & Epstein, A. M. (2016). Readmissions, observation, and the hospital readmissions reduction program. New England Journal of Medicine, 374(16), 1543-1551. doi:10.1056/NeJmsa1513024.

Mittal, M., Wang, C. H. E., Goben, A. H., & Boyd, A. D. (2018). Proprietary management and higher readmission rates: A correlation. PLoS ONE, 13(9). doi:10.1371/journal.pone.0204272.

Newgard, C. D., Mann, N. C., Hsia, R. Y., Bulger, E. M., Ma, O. J., Staudenmayer, K., Haukoos, J. S., Sahni, R., & Kuppermann, N. (2013). Patient choice in the selection of hospitals by 9-1-1 emergency medical services providers in trauma systems. Academic Emergency Medicine, 20(9), 911–919. doi:10.1111/acem.12213.

U. S. Center for Medicare and Medicaid Services. (2022). Hospital Readmissions Reduction Program. Provider data catalog. U. S. Center for Medicare and Medicaid Services (CMS), Baltimore, United States. Available online: https://data.cms.gov/provider-data/dataset/9n3s-kdb3 (accessed on April 2022).

Newgard, C. D., Fu, R., Bulger, E., Hedges, J. R., Mann, N. C., Wright, D. A., ... & Hansen, M. (2017). Evaluation of rural vs. urban trauma patients served by 9-1-1 emergency medical services. JAMA surgery, 152(1), 11-18. doi:10.1001/jamasurg.2016.3329.

Jindal, R. P., Gauri, D. K., Singh, G., & Nicholson, S. (2018). Factors influencing hospital readmission penalties: Are they really under hospitals’ control? Decision Support Systems, 110, 58–70. doi:10.1016/j.dss.2018.03.006.


Full Text: PDF

DOI: 10.28991/SciMedJ-2022-04-02-03

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