Research drills down on regional readmission rates for heart failure

A recent study concludes that differences in regional readmission rates for heart failure are more closely connected with the availability of care and socioeconomics rather than with hospital performance or a patient’s degree of illness. The research was presented at last week's American Heart Association Quality of Care and Outcomes Research Scientific Sessions in Atlanta.

Regional readmission rates for heart failure vary widely - from 10 percent to 32 percent - the researchers found. Communities with higher rates were likely to have more physicians and hospital beds and their populations were likely to be poor, African American and relatively sicker. People 65 and older are also readmitted more frequently, according to the study.

To cut costs, next year the Centers for Medicare & Medicaid Services (CMS) plans to penalize hospitals with higher readmission rates related to heart failure, heart attack and pneumonia. Hospitals with higher-than-average 30-day readmission rates will face reductions in Medicare payments.

However, those penalties don’t address the supply and societal influences that can increase readmission rates, said Karen Joynt, the lead author of the study and an instructor at Brigham and Women’s Hospital, Harvard Medical School and the Harvard School of Public Health in Boston.

“We have to find ways to help hospitals and communities address this problem together, as opposed to putting the burden on hospitals alone,” said Joynt in a written statement. “We need to think less about comparing hospitals to each other in terms of their performance and more about looking at improvement in hospitals and communities.”

Researchers found:

  • Supply-side factors - including availability of doctors and hospitals beds - were the strongest predictors of differences in readmission rates, accounting for 17 percent.
  • Poverty and minority racial makeup was linked to 9 percent of the variation in readmission rates.

  • Hospital-performance quality accounted for 5 percent and patients’ degree of illness 4 percent.

“The vast majority of the readmissions are related to community- and population-based factors. So the concern is if the hospitals in certain communities will be penalized for readmission rates, they will be the ones that already face the greatest disparities and this will exasperate the problems,” said Gregg Fonarow, director, of Ahmanson-UCLA Cardiomyopathy Center. “These penalties are not really addressing many factors that are influencing the readmission rates.”

Researchers analyzed national billing records of more than 3,000 hospitals in 2008-09 for more than one million elderly Medicare patients with heart failure. Of the patients in the review, 55 percent were female, 11 percent were African American and they had an average age of 81. The observational analysis didn’t include all potential influences, such as other illnesses, Joynt said.

“The authors suggest that rather than directly comparing hospitals to one another, instead look at improving performances over time and looking at the whole continuum of care,” said Fonarow. “There was research recently published that focusing on one issue like readmissions really distorts what we’re trying to do overall in providing the best care. We should be preventing admissions to begin with. Not just one issue will have a true cost impact on care.”

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