With penalties rising for hospitals with high readmission rates, the solution may be to keep patients a day longer, researchers at Columbia Business School concluded.
Executive Summary
When researchers at Columbia Business School reviewed Medicare records, they concluded that an extra day in the hospital decreases the readmission rate and mortality risk for some patients.
- They examined the charts of more than 6.6 million Medicare patients who were hospitalized for pneumonia, heart failure, or heart attack.
- They concluded that one more day in the hospital cuts the risk of readmission for heart failure patients by 7%.
- The extra day lowered the mortality rate for pneumonia and heart attack patients.
“Given the stiff penalties imposed under the Affordable Care Act, hospitals are implementing a variety of approaches to aggressively reduce readmission rates, most commonly involving outpatient care,” says Ann P. Bartel, BA, MA, PhD, professor of finance and economics at Columbia Business School.
“While some types of outpatient interventions can be effective, our study shows that hospitals should consider keeping some of their patients in the hospital longer to reduce readmissions and mortality,” she adds.
Bartel worked on the project with Carri Chan, PhD, associate professor of decision, risk and operations at Columbia Business School, and Hailey Kim, PhD, postdoctoral associate in operations management at Yale’s School of Management.
The researchers reviewed the charts of more than 6.6 million Medicare patients who were hospitalized for pneumonia, heart failure, or heart attack from 2008 to 2011 to determine how long they were in the hospital. “We took into account any other conditions patients had at the time of admission, their age, gender, and other factors,” she says.
The three researchers concluded that one more day in the hospital decreases the risk of readmissions by 7% for heart failure patients with high severity. The researchers did not find a relationship between readmissions and length of stay for pneumonia and acute myocardial infarction patients, but the research did show that a longer length of stay can reduce mortality risks by 22% for pneumonia patients and 7% for heart attack patients, Bartel says.
“Some factors that cause readmissions are out of the control of the hospital. But there are things that hospitals can do to reduce readmissions, and one is to keep patients an extra day,” she says.
Many hospitals try to reduce readmissions using outpatient management and having a nurse or another person follow up to make sure patients are taking their medication and following their treatment plan, but that might not be the most cost-effective way, Bartel points out.
“We analyzed the existing data to determine if it would make more sense from a cost-effective standpoint to keep patients one extra day rather than use outpatient management. We concluded that, depending on the actual costs of both options, keeping patients an extra day could be more cost-effective than the outpatient management programs currently in place,” she says.
The researchers determined that for heart failure patients, the inpatient and outpatient interventions have almost identical impact in reducing readmissions. But with heart attack and pneumonia patients, extending the length of stay by one day can potentially save five to six times as many lives as an outpatient program.
The extra day may allow patients to reach a higher level of stability as well as providing more time for the staff to educate the patients on their post-discharge care plan, Bartel says.
In addition, the team concluded that patients who were admitted on a Sunday or Monday typically had a shorter length of stay than those who were admitted on a Tuesday, Wednesday, or Thursday. “If patients are approaching the last day of their stay and it bumps up against the weekend, they are more likely to be discharged prematurely and more likely to be readmitted within 30 days,” Bartel says.
For more information, visit http://www.columbia.edu/~cc3179/medicare_2014.pdf
