That is what you would expect from an individual and this seems to incentivize organizations to act collectively to move in the same direction.
We are always careful about what is cause and effect. We know that readmissions penalties were followed by declines in readmissions, and they did so in a dose-dependent fashion; the more penalties you got the more you declined.
If I take off my epidemiologist hat, it does look like they work. The data is consistent with readmissions penalties working.
HLM: Were patients' socio-demographics factored into your findings?
Yeh: We did find that those hospitals that had the worst readmission rates and incurred the highest penalties were the hospitals that treated a higher percentage of minority of patients, a higher percentage of dual-eligible patients, a higher percentage of women, and the patient characteristics did look like they had more co-morbidities.
Those hospitals tended to be large, academic urban hospitals.
One of our concerns going in was that perhaps those hospitals that have high readmission rates were being penalized for things they can't control, but that is not support by the data.
If those hospitals had no control over their readmission rates, we would not have expected them to lower their readmission rates more dramatically than any other group. But it was quite clear that it was especially those hospitals that reacted the most favorably to the readmission penalties by dropping their readmission rates most significantly.
They dropped at about a 25% faster clip than hospitals that were not penalized.
HLM: Should socio-demographics be a factor in readmissions metrics?
Yeh: It's a broader debate than what we were able to look at in this study, but personally, I do think there are important socioeconomic factors that influence readmission rates that have nothing to do with the care those hospitals provide. They have to do with community resources and cultural influences on healthcare practices and outpatient medical care provided.
I sit on both sides. I see it as important to factor in. At the same time, these are exactly the types of hospitals that you want to see improve. In some ways by giving those hospitals a cushion for taking care of these patients, do you disincentivize them from improving? That is a two-edged sword and that is why there is such a fierce debate. The truth lies somewhere in the middle.
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.