Journal article
Cost of readmission: can the Veterans Health Administration (VHA) experience inform national payment policy?
Medical care, Vol.51(1), pp.13-19
01/2013
DOI: 10.1097/MLR.0b013e31825c2fec
PMID: 22683595
Abstract
Scrutiny of hospital readmissions has led to the development and implementation of policies targeted at reducing readmission rates.
To assess whether historic hospital readmission rates predict risk-adjusted patient readmission and to measure the costs of readmission, thus informing reimbursement policies under consideration by non-Veterans Health Administration payers.
Multivariable hospital-fixed effects regression analyses of patients admitted to 129 Veterans Health Administration hospitals between 2005 and 2009 for 3 common conditions, acute myocardial infarction (AMI), community-acquired pneumonia (CAP), and congestive heart failure (CHF).
We examined whether previous hospital readmission rates predicted risk-adjusted readmission or 30-day episode cost of care for subsequent patients. We then examined the 30-day inpatient hospitalization episode cost differences between those who had a readmission in the episode and those who did not.
Hospital readmission rates in the previous quarter are not predictive of individual patient risk-adjusted readmission or of patients' inpatient hospitalization episode cost in the subsequent quarter. Relative to those who were not readmitted within 30 days of index visit discharge, readmitted patients had 30-day episode costs that were 53.3% (P<0.001), 82.8% (P<0.001), and 79.8% (P<0.001) higher for AMI, CAP, and CHF hospitalization episodes, respectively.
Previous hospital readmission rates are poor predictors of readmission for future individual patients, therefore, policies using these measures to guide subsequent reimbursement are problematic for hospitals that are financially constrained. Our findings indicate current diagnosis related group payments would need to be raised by 10.0% for AMI, 11.5% for CAP, and 16.6% for CHF if these are to become 30-day bundled payments.
Details
- Title: Subtitle
- Cost of readmission: can the Veterans Health Administration (VHA) experience inform national payment policy?
- Creators
- Jason M Hockenberry - Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA, USA. jason.hockenberry@emory.eduJames F Burgess JrJustin GlasgowMary Vaughan-SarrazinPeter J Kaboli
- Resource Type
- Journal article
- Publication Details
- Medical care, Vol.51(1), pp.13-19
- Publisher
- United States
- DOI
- 10.1097/MLR.0b013e31825c2fec
- PMID
- 22683595
- ISSN
- 0025-7079
- eISSN
- 1537-1948
- Grant note
- T32 GM007337 / NIGMS NIH HHS
- Language
- English
- Date published
- 01/2013
- Academic Unit
- Health Management and Policy; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984063129702771
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