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Can all cause readmission policy improve quality or lower expenditures? A historical perspective on current initiatives

Published online by Cambridge University Press:  30 August 2013

James F. Burgess Jr.  and
Jason M. Hockenberry
James F. Burgess Jr.
Affiliation:
Senior Investigator, Center for Organization, Leadership and Management Research, VA Boston Healthcare System Professor, Department of Health Policy and Management, Boston University
Jason M. Hockenberry*
Affiliation:
Assistant Professor, Department of Health Policy and Management, Emory UniversityInvestigator at Center for Comprehensive Access Delivery Research and Evaluation (CADRE) Faculty Research Fellow, National Bureau of Economic Research (NBER)
*
*Correspondence to: Jason M. Hockenberry, 1518 Clifton Road, Atlanta, GA 30322, USA. Email: jason.hockenberry@emory.edu
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Abstract

All-cause readmission to inpatient care is of wide policy interest in the United States and a number of other countries (Centers for Medicare and Medicaid Services, in the United Kingdom by the National Centre for Health Outcomes Development, and in Australia by the Australian Institute of Health and Welfare). Contemporary policy efforts, including high powered incentives embedded in the current US Hospital Readmission Reduction Program, and the organizationally complex interventions derived in anticipation of this policy, have been touted based on potential cost savings. Strong incentives and resulting interventions may not enjoy the support of a strong theoretical model or the empirical research base that are typical of strong incentive schemes. We examine the historical broad literature on the issue, lay out a ‘full’ conceptual organizational model of patient transitions as they relate to the hospital, and discuss the strengths and weaknesses of previous and proposed policies. We use this to set out a research and policy agenda on this critical issue rather than attempt to conduct a comprehensive structured literature review. We assert that researchers and policy makers should consider more fundamental societal issues related to health, social support and health literacy if progress is going to be made in reducing readmissions.

Type
Articles
Information
Health Economics, Policy and Law , Volume 9 , Issue 2 , April 2014 , pp. 193 - 213
Copyright
Copyright © Cambridge University Press. This is a work of the U.S. Government and is not subject to copyright protection in the United States. 2013 

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References

Anderson, G. F.Steinberg, E. P. (1984), ‘Hospital readmissions in the Medicare population’, The New England Journal of Medicine, 311: 1349–1353.CrossRefGoogle ScholarPubMed
Anderson, G. F.Steinberg, E. P. (1985), ‘Predicting hospital readmissions in the Medicare population’, Inquiry, 22: 251–258.Google ScholarPubMed
Andraws, R. (2012), ‘International variation in readmission after myocardial infarction’, Journal of the American Medical Association, 307: 1690 author reply 1.CrossRefGoogle ScholarPubMed
Andrews, K. (1986), ‘Relevance of readmission of elderly patients discharged from a geriatric unit’, Journal of the American Geriatrics Society, 34: 5–11.Google Scholar
Baugh, C. W., Venkatesh, A. K.Bohan, J. S. (2011), ‘Emergency department observation units: a clinical and financial benefit for hospitals’, Health Care Management Review, 36: 28–37.Google Scholar
Benzer, J. K., Sullivan, J. L., Williams, S.Burgess, J. F. (2012), ‘One-year cost implications of using mental health care after discharge from a general medical hospitalization’, Psychiatric Services, 63: 672–678.Google Scholar
Berenson, R. A., Paulus, R. A.Kalman, N. S. (2012), ‘Medicare's readmissions-reduction program – a positive alternative’, The New England Journal of Medicine, 366: 1364–1366.CrossRefGoogle Scholar
Berkman, B.Abrams, R. D. (1986), ‘Factors related to hospital readmission of elderly cardiac patients’, Social Work, 31: 99–103.CrossRefGoogle ScholarPubMed
Berkman, B., Dumas, S., Gastfriend, J., Poplawski, J.Southworthe, M. (1987), ‘Predicting hospital readmission of elderly cardiac patients’, Health & Social Work, 12: 221–228.Google Scholar
Bhalla, R.Kalkut, G. (2010), ‘Could Medicare readmission policy exacerbate health care system inequity?’, Annals of Internal Medicine, 152: 111–114.Google Scholar
Brennan, Niall 2012. National Medicare readmission findings: recent data and trends, http://www.academyhealth.org/files/2012/sunday/brennan.pdf [27 February 2013].Google Scholar
Brock, J., Mitchell, J., Irby, K., Stevens, B., Archibald, T., Goroski, A.Lynn, J., Care Transitions Project (2013), ‘Association between quality improvement for care transitions in communities and rehospitalizations among Medicare beneficiaries’, Journal of the American Medical Association, 309: 381–391.CrossRefGoogle ScholarPubMed
Clarke, A. (1990), ‘Are readmissions avoidable?’, British Medical Journal, 301(6761): 1136–1138.Google Scholar
CMS (2012), Part A to Part B rebilling demonstration, http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/CERT/downloads/AB_QA_1213.pdf [10 February 2013].Google Scholar
Cooke, M. W., Higgins, J.Kidd, P. (2003), ‘Use of emergency observation and assessment wards: a systematic literature review’, Emergency Medicine Journal, 20(2): 138–142.Google Scholar
Dardick, K. R.Stein, J. A. (2012), ‘Hospital readmissions and measures of quality’, Journal of the American Medical Association, 307: 361 author reply 2.CrossRefGoogle ScholarPubMed
DHHS (2011), Federal Register, http://www.gpo.gov/fdsys/pkg/FR-2011-08-18/pdf/2011-19719.pdf [5 February 2013].Google Scholar
DesHarnais, S., Kobrinski, E., Chesney, J., Long, M., Ament, R.Fleming, S. (1987), ‘The early effects of the prospective payment system on inpatient utilization and the quality of care’, Inquiry, 24: 7–16.Google ScholarPubMed
Dharmarajan, K., Hsieh, A. F., Lin, Z., Bueno, H., Ross, J. S., Horwitz, L. I., Barreto-Filho, J. A., Kim, N., Bernheim, S. M., Suter, L. G., Drye, E. E.Krumholz, H. M. (2013), ‘Diagnoses and timing of 30-day readmissions after hospitalization for heart failure, acute myocardial infarction, or pneumonia’, Journal of the American Medical Association, 309: 355–363.Google Scholar
Ellrodt, G., Glasner, R., Cadorette, B., Kradel, K., Bercury, C., Ferrarin, A., Jewell, D., Frechette, C., Seckler, P., Reed, J., Langou, A.Surapaneni, N., Multidisciplinary Rounds Team (2007), ‘Multdisciplinary round (MDR): an implementation system for sustained improvement in the American Heart Association's Get with the Guidelines program’, Critical Pathways in Cardiology, 6: 106–116.Google Scholar
Epstein, A. M., Bogen, J., Dreyer, P.Thorpe, K. E. (1991), ‘Trends in length of stay and rates of readmission in Massachusetts: implications for monitoring quality of care’, Inquiry, 28: 19–28.Google Scholar
Evans, R. L., Hendricks, R. D., Lawrence, K. V.Bishop, D. S. (1988), ‘Identifying factors associated with health care use: a hospital-based risk screening index’, Social Science & Medicine, 27: 947–954.Google Scholar
Fethke, C. C., Smith, I. M.Johnson, N. (1986), ‘“Risk” factors affecting readmission of the elderly into the health care system’, Medical Care, 24: 429–437.Google Scholar
Fishbein, H. A., Faich, G. A.Ellis, S. E. (1982), ‘Incidence and hospitalization patterns of insulin-dependent diabetes mellitus’, Diabetes Care, 5: 630–633.CrossRefGoogle ScholarPubMed
Fischer, C., Anema, H. A.Klazinga, N. S. (2011), ‘The validity of indicators for assessing quality of care: a review of the literature on hospital readmission rate’, European Journal of Public Health, 22(4): 484–491.Google Scholar
Fontanarosa, P. B.McNutt, R. A. (2013), ‘Revisiting hospital readmissions’, Journal of the American Medical Association, 309: 398–400.Google Scholar
Future of Hospitals (2013), http://blog.futureofhospitals.org/community-wellness-vs-acute-care [10 February 2013].Google Scholar
Gautam, P., Macduff, C., Brown, I., Squair, J. (1996), ‘Unplanned readmissions of elderly patients’, Health Bulletin, 54(6): 449–457.Google Scholar
Glied, S. (2003), ‘Health care costs: on the rise again’, The Journal of Economic Perspectives, 17: 125–148.Google Scholar
Gooding, J.Jette, A. M. (1985), ‘Hospital readmissions among the elderly’, Journal of the American Geriatrics Society, 33: 595–601.CrossRefGoogle ScholarPubMed
Graff, L. F. 2009. Observation medicine: the healthcare system's tincture of time: ACEP, http://www.acep.org/WorkArea/DownloadAsset.aspx?id=45885 [26 February 2013].Google Scholar
Graham, H.Livesley, B. (1983), ‘Can readmissions to a geriatric medical unit be prevented?’, Lancet, 1: 404–406.Google Scholar
Henderson, J., Goldacre, M. J., Graveney, M. J.Simmons, H. M. (1989), ‘Use of medical record linkage to study readmission rates’, British Medical Journal, 299: 709–713.Google Scholar
Hernandez, A. F.Granger, C. B. (2012), ‘Prediction is very hard, especially about the future: comment on “factors associated with 30-day readmission rates after percutaneous coronary intervention”’, Archives of Internal Medicine, 172: 117–119.Google Scholar
Hockenberry, J. M., Burgess, J. F., Glasgow, J., Vaughan-Sarrazin, M.Kaboli, P. J. (2013), ‘Cost of readmission: can the Veterans Health Administration (VHA) experience inform national payment policy?’, Medical Care, 51(1): 13–19.Google Scholar
Hockenberry, J. M., Burgess, J. F., Glasgow, J., Vaughan-Sarrazin, M.Kaboli, P. J. (2013), ‘Should hospital readmissions be reduced through payment penalties: a response to Dr. Pizer’, Medical Care, 51(1): 23–24.Google Scholar
Hoff, T. (2009), Practice Under Pressure: Primary Care Physicians and their Medicine in the Twenty-First Century, New Brunswick, NJ: Rutgers University Press.Google Scholar
Hoff, T., Weller, W.Depuccio, M. (2012), ‘The patient-centered medical home: a review of recent research’, Medical Care Research and Review, 69(6): 619–644.CrossRefGoogle ScholarPubMed
Holloway, J. J.Thomas, J. W. (1989), ‘Factors influencing readmission risk: implications for quality monitoring’, Health Care Financing Review, 11: 19–32.Google Scholar
Holloway, J. J., Thomas, J. W.Shapiro, L. (1988), ‘Clinical and sociodemographic risk factors for readmission of Medicare beneficiaries’, Health Care Financing Review, 10: 27–36.Google Scholar
Holmstrom, B.Milgrom, P. (1990), ‘Regulating Trade Among Agents’, Journal of Institutional and Theoretical Economics, 146: 85–105.Google Scholar
HR 3590. (2010), Patient Protection and Affordable Care Act. http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm [5 February 2012].Google Scholar
Jencks, S. F., Williams, M. V.Coleman, E. A. (2009), ‘Rehospitalizations among patients in the Medicare fee-for-service program’, The New England Journal of Medicine, 360: 1418–1428.Google Scholar
Jenq, G.Tinetti, M. E. (2012), ‘The journey across the health care (dis)continuum for vulnerable patients: policies, pitfalls, and possibilities’, Journal of the American Medical Association, 307: 2157–2158.Google Scholar
Joynt, K. E.Jha, A. K. (2012), ‘The relationship between cost and quality: no free lunch’, Journal of the American Medical Association, 307: 1082–1083.Google Scholar
Joynt, K. E.Jha, A. K. (2013), ‘Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program’, Journal of the American Medical Association, 309: 342–343.Google Scholar
Kangovi, S.Grande, D. (2011), ‘Hospital readmissions – not just a measure of quality’, Journal of the American Medical Association, 306: 1796–1797.Google Scholar
Kansagara, D., Englander, H., Salanitro, A., Kagen, D., Theobald, C., Freeman, M.Kripalani, S. (2011), ‘Risk prediction models for hospital readmission: a systematic review’, Journal of the American Medical Association, 306: 1688–1698.Google Scholar
Kartha, A., Brower, V., Saitz, R., Samet, J. H., Keane, T. M.Liebschutz, J. (2008), ‘The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients’, Medical Care, 46: 388–393.Google Scholar
Kaboli, P. J., Go, J. T., Hockenberry, J., Glasgow, J. M., Johnson, S. R., Rosenthal, G. E., Jones, M. P.Vaughan-Sarrazin, M. (2012), ‘Associations between reduced hospital length of stay and 30-day readmission and mortality: 14-year experience in 129 Veterans Affairs hospitals’, Annals of Internal Medicine, 157: 837–845.Google Scholar
Katz, M. H. (2011), ‘Interventions to decrease hospital readmission rates: who saves? Who pays?’, Archives of Internal Medicine, 171: 1230–1231.CrossRefGoogle ScholarPubMed
Kociol, R. D., Lopes, R. D., Clare, R., Thomas, L., Mehta, R. H., Kaul, P., Pieper, K. S., Hochman, J. S., Weaver, W. D., Armstrong, P. W., Granger, C. B.Patel, M. R. (2012), ‘International variation in and factors associated with hospital readmission after myocardial infarction’, Journal of the American Medical Association, 307: 66–74.Google Scholar
Krumholz, H. M., Lin, Z., Keenan, P. S., Chen, J., Ross, J. S., Drye, E. E., Bernheim, S. M., Wang, Y., Bradley, E. H., Han, L. F., Normand, S. L. (2013), ‘Relationship between hospital readmission and mortality rates for patients hospitalized with acute myocardial infarction, heart failure, or pneumonia’, Journal of the American Medical Association, 309(6): 587–593.Google Scholar
Kupfer, J. M. (2013), ‘The morality of using mortality as a financial incentive: unintended consequences and implications for acute hospital care’, Journal of the American Medical Association, 309(21): 2213–2214.Google Scholar
Lakhani, A., Coles, J., Eayres, D., Spence, C.Rachet, B. (2005), ‘Creative use of existing clinical and health outcomes data to assess NHS performance in England: Part 1 – performance indicators closely linked to clinical care’, British Medical Journal, 330: 1426–1431.Google Scholar
Laudicella, M., Donni, P., Smith, P.C. , 2012. Hospital readmission rates: signal of failure or success? Imperial College Discussion paper, http://spiral.imperial.ac.uk/bitstream/10044/1/9224/1/Laudicella%202012-02.pdf [15 June 2012].Google Scholar
Lave, J. R.Frank, R. G. (1990), ‘Effect of the structure of hospital payment on length of stay’, Health Services Research, 25(2): 327–347.Google Scholar
Mayes, R.Lee, J. S. (2004), ‘Medicare payment policy and the controversy over hospital cost shifting’, Applied Health Economics and Health Policy, 3: 153–159.Google Scholar
Mor, V., Intrator, O., Feng, Z.Grabowski, D. C. (2010), ‘The revolving door of rehospitalization from skilled nursing facilities’, Health Affairs, 29: 57–64.Google Scholar
McCarthy, D., Johnson, M. B.Audet, A. M. (2013), ‘Recasting readmissions by placing the hospital role in community context’, Journal of the American Medical Association, 309: 351–352.Google Scholar
Milstein, A.Shortell, S. (2012), ‘Innovations in care delivery to slow growth of US health spending’, Journal of the American Medical Association, 308: 1439–1440.CrossRefGoogle Scholar
Nolte, E., Roland, M., Guthrie, S.Brereton, L. (2012), ‘Preventing emergency readmissions to hospital’, RAND Technical report, www.rand.org/pubs/technical_reports/TR1198.htmlGoogle Scholar
Parkes, J.Shepperd, S. (2000), ‘Discharge planning from hospital to home’, Cochrane Database of Systematic Reviews, (4): CD000313.Google Scholar
Pauly, M.Redisch, M. (1973), ‘The not-for-profit hospital as a physician's cooperative’, The American Economic Review, 63(1): 87–99.Google Scholar
Roselle, S.D'Amico, F. J. (1982), ‘The effect of home respiratory therapy on hospital readmission rates of patients with chronic obstructive pulmonary disease’, Respiratory Care, 27: 1194–1199.Google Scholar
Ross, M. A., Compton, S., Richardson, D., Jones, R., Nittis, T.Wilson, A. (2003), ‘The use and effectiveness of an emergency department observation unit for elderly patients’, Annals of Emergency Medicine, 41: 668–677.Google Scholar
Safran, C.Phillips, R. S. (1989), ‘Interventions to prevent readmission: the constraints of cost and efficacy’, Medical Care, 27: 204–211.Google Scholar
Schoen, C., Osborn, R., Squires, D., Doty, M. M., Rasmussen, P., Pierson, R.Applebaum, S. (2012), ‘A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas’, Health Affairs, 31: 2805–2816.Google Scholar
Shortell, S. M., Gillies, R. R.Anderson, D. A. (1994), ‘The new world of managed care: creating organized delivery systems’, Health Affairs, 13(5): 46–64.Google Scholar
Shortell, S. M., Gillies, R. R.Devers, K. J. (1995), ‘Reinventing the American hospital’, The Milbank Quarterly, 73(2): 131–160.Google Scholar
Smith, D. M., Weinberger, M., Katz, B. P.Moore, P. S. (1988), ‘Postdischarge care and readmissions’, Medical Care, 26: 699–708.Google Scholar
Stanton, B. A., Jenkins, C. D., Goldstein, R. L., Vander Salm, T. J., Klein, M. D.Aucoin, R. A. (1985), ‘Hospital readmissions among survivors six months after myocardial revascularization’, Journal of the American Medical Association, 253: 3568–3573.Google Scholar
Stauffer, B. D., Fullerton, C., Fleming, N., Ogola, G., Herrin, J., Stafford, P. M.Ballard, D. J. (2011), ‘Effectiveness and cost of a transitional care program for heart failure: a prospective study with concurrent controls’, Archives of Internal Medicine, 171: 1238–1243.Google Scholar
Townsend, J., Piper, M., Frank, A. O., Dyer, S., North, W. R.Meade, T. W. (1988), ‘Reduction in hospital readmission stay of elderly patients by a community based hospital discharge scheme: a randomised controlled trial’, British Medical Journal, 297: 544–547.Google Scholar
UK Department of Health (2012), Payment by results, http://www.dh.gov.uk/health/category/policy-areas/nhs/resources-for-managers/payment-by-results, [5February 2013].Google Scholar
Vaduganathan, M., Bonow, R. O.Gheorghiade, M. (2013), ‘Thirty-day readmissions: the clock is ticking’, Journal of the American Medical Association, 309: 345–346.Google Scholar
Vashi, A. A., Fox, J. P., Carr, B. G., D'Onofrio, G., Pines, J. M., Ross, J. S.Gross, C. P. (2013), ‘Use of hospital-based acute care among patients recently discharged from the hospital’, Journal of the American Medical Association, 309: 364–371.Google Scholar
Vest, J. R.Gamm, L. D. (2010), ‘Health information exchange: persistent challenges and new strategies’, Journal of the American Medical Informatics Association, 17: 288–294.Google Scholar
Victor, C. R.Vetter, N. J. (1985), ‘The early readmission of the elderly to hospital’, Age Ageing, 14: 37–42.Google Scholar
Vina, E. R., Rhew, D. C., Weingarten, S. R., Weingarten, J. B.Chang, J. T. (2009), ‘Relationship between organizational factors and performance among pay-for-performance hospitals’, Journal of General Internal Medicine, 24: 833–840.Google Scholar
Voss, R., Gardner, R., Baier, R., Butterfield, K., Lehrman, S.Gravenstein, S. (2011), ‘The care transitions intervention: translating from efficacy to effectiveness’, Archives of Internal Medicine, 171: 1232–1237.Google Scholar
Weinberger, M., Smith, D. M., Katz, B. P.Moore, P. S. (1988), ‘The cost-effectiveness of intensive postdischarge care. A randomized trial’, Medical Care, 26: 1092–1102.Google Scholar
Whitney, E. (2012), ‘Denver health: readmission rates not so easy to emulate’, Kaiser Health News, http//:capsules.kaiserhealthnews.org/?p=12341 [10 August 2012].Google Scholar
Williams, E. I.Fitton, F. (1988), ‘Factors affecting early unplanned readmission of elderly patients to hospital’, British Medical Journal, 297: 784–787.Google Scholar
Williams, M. V. (2013), ‘A requirement to reduce readmissions: take care of the patient not just the disease’, Journal of the American Medical Association, 309: 394–396.Google Scholar