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Readmission Responsibility Extends Beyond Hospitals

By Christopher Cheney  
   February 05, 2015

Individual hospital performance accounts for less than half of the variation in pooled readmission rates across the United States, researchers find.

County-based data collected from across the country show hospitals are far from solely responsible for readmission rates.

An analysis of the data, which is slated for publication this month in the journal Health Services Research, features information collected from 4,000 hospitals for patients with three conditions: acute myocardial infarction, heart failure, and pneumonia. The key finding of the study, "Community Factors and Hospital Readmission Rates," is that 58% of the variation in readmission rates was related to community characteristics outside a hospital's control.

Jeph Herrin, PhD, lead author, says several elements of a community's health capabilities that are not under hospital control help drive readmissions. "The health system outside the hospital, independent of any socioeconomic status characteristics, is important to understanding geographic differences in readmission rates," Herrin said in an interview.

"Our results indicate that at least some of the accountability should be shifted away from hospitals," he says.

The study comes as hospitals are facing growing financial penalties over readmissions. The Centers for Medicare & Medicaid Services' the Hospital Readmissions Reduction Program cuts a hospital's aggregate Medicare reimbursement if a facility reports higher-than-expected 30-day, risk-adjusted readmission rates for patients 65 years and older. The penalties were phased in, starting with up to a 1% Medicare reimbursement cut starting Oct. 1, 2012, and rising to up to 3%, effective Oct. 1, 2014.

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

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