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30-Day Readmissions Penalty Draws Fire

By Christopher Cheney  
   May 01, 2018

Researchers find that hospitals are most likely to be responsible for readmissions within a week of discharge, but outpatient clinics and homecare givers are most likely responsible for later readmissions.

Hospital readmissions are not monolithic, and Medicare should change its readmissions penalty program time frame from 30 days to seven days, researchers say.

The researchers, whose study was published this week in the Annals of Internal Medicine, say Medicare's Hospital Readmissions Reduction Program (HRRP) often penalizes hospitals for patient outcomes that are out of their control.

"We found that readmissions within the first 7 days after hospital discharge were more likely to be preventable than those within a late period of 8 to 30 days," the researchers wrote. "Early readmissions were more likely to be amenable to interventions within the hospital and to be caused by factors for which the hospital is directly accountable, such as problems with physician decision making."

Outpatient facilities and home caregivers were more likely to be accountable for readmissions from eight to 30 days, the researchers wrote.

"Late readmissions were more likely to be amenable to interventions outside the hospital and to be caused by factors over which the hospital has less direct control, such as appropriate monitoring and managing of symptoms after discharge by the primary care team."

The study, which covered 10 academic medical centers from April 2012 through March 2013, included 822 adult patients:

  • 301 patients (36.6%) were readmitted within seven days after discharge
  • 521 (63.4%) were readmitted eight to 30 days after discharge
  • 36.2% of early readmissions vs. 23.0% of late readmissions were deemed preventable

The researchers found that faulty physician decision making was the number one cause of early readmissions, associated with 28.9% of the cases.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


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