Nine Factors Fuel Readmissions from Rehab Hospitals.
In recent years, federal Medicare officials have been closely scrutinizing—and penalizing—hospitals for readmitting patients who have been discharged within the prior 30 days.
Now, a new study co-authored by a School of Public Health professor points to nine characteristics that “significantly increase” the odds of medically complex patients being readmitted to acute care hospitals from inpatient rehabilitation facilities (IRFs).
The study, in the Journal of the American Medical Directors Association, examined the variation in 30-day readmission rates among more than 117,000 medically complex patients at 682 IRFs nationwide, from 2002 to 2011. The average age of patients was 71.5.
The authors examined 16 patient and facility characteristics to identify which ones had the most significant impact on readmission rates. Nine of the 16 factors were identified as significant, including: older age, male gender, poor admission motor function, longer duration of impairment, unemployed or retired status, and larger facility size.
IRFs are freestanding rehabilitation hospitals and rehabilitation units in acute care hospitals.
“Facilities with the highest readmission rates more commonly cared for patients at highest risk for readmission: unemployed, male patients with higher comorbidity index and poorer motor function on admission,” the authors said.
They said 41 percent of the variation in readmission rates was attributed to the nine characteristics, “suggesting the need for risk adjustment if readmission rates are to be used as a quality indicator for IRFs.”
The National Quality Forum recently identified 30-day readmission rates as a quality indicator for IRFs and, as of October 1, 2016, IRF readmission rates will be published publicly as a performance measure. Further, as of April 1, 2016, bundled payment systems for Medicare patients were mandated across 800 hospitals nationwide. Under this model, high readmission rates from IRFs will result in diminishing returns to both acute care hospitals and IRFs.
Lewis Kazis, professor of health law, policy and management, was a co-author on the study, which was led by researchers from Spaulding Rehabilitation Hospital, including Lindsay Ramey and Jeff Schneider.
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