Using same-hospital readmission rates to estimate all-hospital readmission rates

Andrew A. Gonzalez, Terry Shih, Justin B. Dimick, Amir A. Ghaferi

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Study: Design We evaluated 3,940 hospitals treating 741,656 Medicare fee-for-service beneficiaries undergoing CABG, hip fracture repair, or colectomy between 2006 and 2008. We used hierarchical logistic regression to calculate risk- and reliability-adjusted rates of 30-day readmission to the same hospital and to any hospital. We next evaluated the correlation between same-hospital and all-hospital rates. To analyze the impact on hospital profiling, we compared rankings based on same-hospital rates with those based on all-hospital rates.

Background: Since October of 2012, Medicare's Hospital Readmissions Reduction Program has fined 2,200 hospitals a total of $500 million. Although the program penalizes readmission to any hospital, many institutions can only track readmissions to their own hospitals. We sought to determine the extent to which same-hospital readmission rates can be used to estimate all-hospital readmission rates after major surgery.

Results: The mean risk- and reliability-adjusted all-hospital readmission rate was 13.2% (SD 1.5%) and mean same-hospital readmission rate was 8.4% (SD 1.1%). Depending on the operation, between 57% (colectomy) and 63% (CABG) of hospitals were reclassified when profiling was based on same-hospital readmission rates instead of on all-hospital readmission rates. This was particularly pronounced in the middle 3 quintiles, where 66% to 73% of hospitals were reclassified.

Conclusions: In evaluating hospital profiling under Medicare's Hospital Readmissions Reduction Program, same-hospital rates provide unstable estimates of all-hospital readmission rates. To better anticipate penalties, hospitals require novel approaches for accurately tracking the totality of their postoperative readmissions.

Original languageEnglish (US)
Pages (from-to)656-663
Number of pages8
JournalJournal of the American College of Surgeons
Volume219
Issue number4
DOIs
StatePublished - Oct 1 2014
Externally publishedYes

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Patient Readmission
Medicare
Colectomy
Fee-for-Service Plans
Hip Fractures

ASJC Scopus subject areas

  • Surgery

Cite this

Using same-hospital readmission rates to estimate all-hospital readmission rates. / Gonzalez, Andrew A.; Shih, Terry; Dimick, Justin B.; Ghaferi, Amir A.

In: Journal of the American College of Surgeons, Vol. 219, No. 4, 01.10.2014, p. 656-663.

Research output: Contribution to journalArticle

Gonzalez, Andrew A. ; Shih, Terry ; Dimick, Justin B. ; Ghaferi, Amir A. / Using same-hospital readmission rates to estimate all-hospital readmission rates. In: Journal of the American College of Surgeons. 2014 ; Vol. 219, No. 4. pp. 656-663.
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