Hospital readmission rate varies following care at rehabilitation facility

February 11, 2014

Among rehabilitation facilities providing services to Medicare fee-for-service patients, 30-day hospital readmission rates vary, from about 6 percent for patients with lower extremity joint replacement to nearly 20 percent for patients with debility (weakness or feebleness), according to a study in the February 12 issue of JAMA.

The Centers for Medicare & Medicaid Services (CMS) recently identified 30-day hospital as a national quality indicator for inpatient rehabilitation facilities; reporting will be required in 2014 by the CMS, according to background information in the article.

Kenneth J. Ottenbacher, Ph.D., of the University of Texas Medical Branch, Galveston, Texas, and colleagues conducted a study to determine 30-day and factors related to readmission for receiving postacute inpatient rehabilitation. The study included records for 736,536 Medicare fee-for- beneficiaries discharged from 1,365 inpatient rehabilitation facilities to the community between 2006 and 2011. Readmission rates were examined for the 6 most common reasons for receiving inpatient rehabilitation: stroke, lower extremity fracture, lower extremity joint replacement, neurologic disorders, brain dysfunction and debility.

Average rehabilitation length of stay was 12 days. The overall 30-day readmission rate was 11.8 percent, with rates ranging from 5.8 percent for patients with lower extremity joint replacement to 18.8 percent for patients with debility. Rates were highest in men, non-Hispanic blacks, and for persons with longer lengths of stay. Higher motor and cognitive ratings, indicating better patient function, were consistently related to lower readmission rates across all 6 categories. Rates were similar for rural vs urban facilities and freestanding vs hospital-based facilities.

Approximately 50 percent of patients rehospitalized within the 30-day period were readmitted within 11 days of discharge. The most common reasons for readmission (per diagnosis codes) were heart failure, urinary tract infection, pneumonia, septicemia (blood poisoning), nutritional and metabolic disorders, esophagitis (inflammation of the esophagus), gastroenteritis, and digestive disorders.

The authors write that Medicare is currently examining bundled payment models designed to improve quality and contain costs. "The payment options cover different periods and include multiple health care professionals and settings. In the context of bundled payment, what happens to patients during post-acute care becomes important in the management of resources, quality, cost, and readmissions. Recent research has demonstrated that most of the variation in Medicare spending across geographic areas is attributable to postacute care. Readmission will likely add to the cost variation."

"Questions regarding the validity of readmission as a quality indicator are likely to increase as the accountability for readmission expands to include postacute care settings. Although readmission is an imperfect quality indicator, it has the potential to serve as a platform for efforts to improve patient transitions and care continuity associated with bundling and other initiatives proposed by the Affordable Care Act to reduce cost and improve health outcomes."

Explore further: Improved outcomes seen with ventricular assist devices

More information: DOI: 10.1001/jama.2014.8

Related Stories

Improved outcomes seen with ventricular assist devices

January 31, 2014
(HealthDay)—Among Medicare patients receiving implantation of ventricular assist devices (VADs) for advanced heart failure, mortality has decreased, but readmission rates did not change, according to research published ...

Hospital readmission rates linked with quality of surgical care

September 18, 2013
Reducing hospital readmission rates is an important clinical and policy priority but whether those rates really measure the quality of hospital care isn't clear. In a new study, researchers from Harvard School of Public Health ...

Inpatient diabetes education linked to lower readmissions

October 18, 2013
(HealthDay)—Inpatients diagnosed with diabetes who receive inpatient diabetes education (IDE) have significantly lower frequency of all-cause hospital readmission within 30 days, according to a study published in the October ...

Hospitals serving elderly poor more likely to be penalized for readmissions

January 8, 2014
Hospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties from the Centers for Medicare and Medicaid Services (CMS), finds a new study ...

Same-hospital readmission rate an unreliable predictor for all-hospital readmission rate

October 8, 2013
Approximately one in five Medicare patients are rehospitalized within 30 days of discharge.* The Centers for Medicare & Medicaid Services (CMS) considers this rate excessive, and began reducing payments to hospitals that ...

Role of chronic medical conditions in readmissions

December 23, 2013
Researchers cite identification and monitoring of known underlying chronic medical conditions as opportunities to reduce readmission rates and improve patient safety.

Recommended for you

To combat teen smoking, health experts recommend R ratings for movies that depict tobacco use

July 21, 2017
Public health experts have an unusual suggestion for reducing teen smoking: Give just about any movie that depicts tobacco use an automatic R rating.

Why sugary drinks and protein-rich meals don't go well together

July 20, 2017
Having a sugar-sweetened drink with a high-protein meal may negatively affect energy balance, alter food preferences and cause the body to store more fat, according to a study published in the open access journal BMC Nutrition.

Aging Americans enjoy longer life, better health when avoiding three risky behaviors

July 20, 2017
We've heard it before from our doctors and other health experts: Keep your weight down, don't smoke and cut back on the alcohol if you want to live longer.

Opioids and obesity, not 'despair deaths,' raising mortality rates for white Americans

July 20, 2017
Drug-related deaths among middle-aged white men increased more than 25-fold between 1980 and 2014, with the bulk of that spike occurring since the mid-1990s when addictive prescription opioids became broadly available, according ...

Parents have critical role in preventing teen drinking

July 20, 2017
Fewer teenagers are drinking alcohol but more needs to be done to curb the drinking habits of Australian school students, based on the findings of the latest study by Adelaide researchers.

Fresh fish oil lowers diabetes risk in rat offspring

July 19, 2017
Fresh fish oil given to overweight pregnant rats prevented their offspring from developing a major diabetes risk factor, Auckland researchers have found.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.