According to a new study presented at the American Heart Association's (AHA) Quality of Care & Outcomes Research Scientific Sessions 2012, differences in regional hospital readmission rates for heart failure have more to do with the availability of care and socioeconomics than to hospital performance or patients' degree of illness. The research stated readmission rates for heart failure vary widely ― from 10 percent to 32 percent ― and communities with higher rates were likely to have more physicians and hospital beds and their populations were likely to be poor, black, and relatively sicker. It also found people 65 and older were readmitted more frequently.
The research said the Centers for Medicare and Medicaid Services’ (CMS) upcoming plans to penalize hospitals with higher readmission rates related to heart failure, heart attack, and pneumonia don't address the supply and societal influences that can increase readmission rates. Next year, hospitals with higher-than-average 30-day readmission rates will face reductions in Medicare payments.
"We have to find ways to help hospitals and communities address this problem together, as opposed to putting the burden on hospitals alone," Karen E. Joynt, M.D., lead author of the study and an instructor at Brigham and Women's Hospital, Harvard Medical School and the Harvard School of Public Health in Boston, said in a statement. "We need to think less about comparing hospitals to each other in terms of their performance and more about looking at improvement in hospitals and communities."
Things such as supply side availability, such as doctors and hospital beds, the researchers found impacted the readmission rates results most, accounting for 17 percent. Poverty and minority racial makeup was linked to nine percent of the variation in readmission rates. According to the researchers, hospital-performance quality accounted for five percent and patients' degree of illness four percent.
"To really address the readmissions issue, we need to think about this in terms of community and population health," Joynt said. "Focusing on community-level factors ― such as the supply and mix of physicians and targeting efforts towards poor and minority communities ― may be more fruitful approaches to reducing readmissions We need to think outside the walls of the hospital."
To get the results, the researchers analyzed national billing records of more than 3,000 hospitals in 2008-09 for more than one million elderly Medicare patients with heart failure. Of the patients in the review, 55 percent were female, 11 percent were black and they had an average age of 81.