Nearly 12 percent of Medicare patients who receive inpatient rehabilitation following discharge from acute-care hospitalization are readmitted to the hospital within 30 days after discharge from the rehabilitation facility according to new research published in the Feb. 12 issue of the Journal of the American Medical Association. Before now, there was a lack of research on the frequency and causes of patients returning to hospital after rehabilitation.
The new research reports 30-day hospital readmission rates across rehabilitation impairment categories and examines whether readmissions are associated with patient socio-demographics, clinical characteristics, functional status or facility factors. The authors say this type of data is important because Medicare is in the process of developing new payment models associated with health care reform.
"Currently, Medicare spends $20 billion each year on readmissions of hospitalized older adults," said lead author Kenneth Ottenbacher of the University of Texas Medical Branch at Galveston. "The data uncovered in this study is crucial in order to effectively develop new health reimbursement systems that bundle acute and post-acute care to improve quality and contain costs."
This research is especially timely because, starting this year, the Centers for Medicare and Medicaid Services will begin using 30-day readmission as a national quality indicator for inpatient rehabilitation facilities.
The study evaluated patients from the six largest impairment categories, which represent approximately 75 percent of Medicare fee-for-service patients receiving inpatient rehabilitation: stroke, lower extremity fracture, lower extremity joint replacement, debility, neurological disorders, and brain dysfunction.
Researchers analyzed data from CMS files covering 1,365 post-acute rehabilitation facilities, representing 736,536 post-acute patients discharged from inpatient rehabilitation facilities from 2006 through 2011. The mean patient age was 78.0 (SD = 7.3) years. The majority of patients were female (62.5 percent) with 85.1 percent non-Hispanic white. The mean rehabilitation length of stay was 12.4 (SD = 5.3) days.
The total 30-day hospital readmission rate among patients discharged from a rehabilitation facility to the community was 11.8 percent. Among the six impairment categories, lower extremity joint replacement had the lowest readmission rate for patients at 5.8 percent, while debility had the highest readmission rate at 18.8 percent. Readmission rates were higher for men and non-Hispanic blacks and for persons with longer lengths of stay. Approximately 50 percent of patients included in the study were readmitted within 11 days after discharge.
Researchers noted similar readmission rates between rural and urban facilities and freestanding and hospital-based facilities. Geographic variation of readmission rates varied between 9.2 percent and 13.6 percent, with the lowest rates found in Idaho and Washington and the highest rate found in Michigan.
Across the facilities included in the study, authors noted several diagnosis-related groups readmitted more frequently for all impairment categories, including kidney and urinary tract infections, pneumonia and nutritional and miscellaneous metabolic disorders.
These findings in particular may represent potential targets for early intervention to reduce readmission rates.
- Kenneth J. Ottenbacher, Amol Karmarkar, James E. Graham, Yong-Fang Kuo, Anne Deutsch, Timothy A. Reistetter, Soham Al Snih, Carl V. Granger. Thirty-Day Hospital Readmission Following Discharge From Postacute Rehabilitation in Fee-for-Service Medicare Patients. JAMA, 2014; 311 (6): 604 DOI: 10.1001/jama.2014.8
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