Prospective Payment System May Encourage Readmissions

Hospitals incentivized to release patients too early, study suggests

Better coordination between hospitals and post-acute care facilities could reduce patient readmission to hospitals and mortality rates, according to a new study of risk factors conducted by researchers at the University of Colorado’s Anschutz School of Medicine.

In a review of more than 3,200 hospitalizations followed by stays in post-acute care facilities, the researchers found specific risk factors that may contribute to the need for readmission to the hospital. Nearly half of the readmissions occurred within 14 days of being released from the hospital. 

The study, published online in the Journal of Post-Acute and Long Term Care Medicine, identified the patient’s need for an invasive device, such as a feeding tube or urinary catheter, and for advanced care, such as dialysis and oxygen therapy, as factors more common in readmitted patents.

The causes of hospital readmission from post-acute care facilities, also called skilled nursing facilities, are critical areas to study in order to improve the quality of patient care and to prepare for reimbursement models that penalize hospitals if patients are readmitted, according to the researchers.

“Patients who experienced readmission during their stay in a post-acute care facility were less likely to return to the community,” said lead author Robert Burke, MD.

In addition, readmitted patients had a higher mortality rate. “Readmitted patients were twice as likely as non-readmitted patients to die in the 30 days following hospital discharge and nearly four times as likely to die in the 100 days post-hospital discharge,” the authors write.

The authors also found that payment systems matter and affect patient outcomes. 

“Under a prospective payment system, hospitals are incentivized to discharge these patients as early as possible, and in contrast to discharges home, hospitals are not currently penalized for readmissions from PAC [post-acute care] facilities,” the authors write. “PAC facilities may be substituting for prolonged hospital care in some cases.”

Hospitals and post-acute care facilities need to focus on patient selection and on processes for transitioning care from the hospital to the post-acute care facility, the authors conclude.

Source: UC School of Medicine; January 15, 2016.

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