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Readmission Penalties are Punishing Safety-Net Hospitals

By HealthLeaders Media News  
   November 10, 2016

Health disparities are key drivers of readmissions in hospitals treating underserved populations, research shows.

Rather than medical treatments, health disparities disproportionately drive many hospital readmissions, leading to correspondingly high volumes of penalties for hospitals treating large numbers of underserved patients.

Factors such as race, income, and insurance status are large factors in readmissions, according to researchers.

Researchers at MedStar Georgetown University Hospital studied readmissions after colorectal surgery, which has a high risk for postoperative complications and hospital readmissions within 30 days of discharge.

The researchers examined outcomes and patient factors in more than 168,000 colorectal surgery patients treated in 374 California hospitals from 2004-2011.

Forty-seven of these hospitals were considered minority-serving hospitals, treating a high percentage of minority patients. Hispanic and black patients comprise 63% of the patient population in minority-serving hospitals, compared with 17% in other hospitals.

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After accounting for a patient's age, gender, comorbidities, and year and type of procedure, the researchers found that, overall, 30-day, 90-day, and repeated readmission rates were 11.6%, 17.4%, and 3%, respectively.

In comparison, the rates in minority-serving hospitals were 13.6%, 20.1%, and 4%, respectively. Inpatient mortality was also significantly higher at minority-serving hospitals (4.9%) compared to non-minority-serving hospitals (3.8%).

Patient factors (race, low income, and insurance status) accounted for up to 65% of the observed increase in odds for readmission at minority-serving hospitals, the investigators found.

Hospital-level factors (such as procedure volume and procedure type) accounted for up to 40% of the increase.

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