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Medicare & Medicaid News

Readmission Rates Lowest for Medicare Rehab Patients With Lower Joints Replaced

Most likely to be back into rehab within 30 days are those being treated for being weak or feeble says JAMA report that takes look at new CMS quality measure

Feb. 11, 2014 - As part of its effort to emphasize quality care, the Centers for Medicare & Medicaid Services has established readmission rates as a way to measure performance for inpatient rehabilitation facilities. A new study of such readmissions for Medicare fee-for-service patients has found the rate of return to the facility within 30 days is the lowest – 6 percent - for those who had joints replaced in their lower extremities and highest – 20 percent - for those treated for debility (weakness or feebleness).

Reporting on 30-day hospital readmission will be required in 2014 by the CMS, according to background information in the article to be published the February 12 issue of the Journal of the American Medical Association (JAMA).


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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.

Kenneth J. Ottenbacher, Ph.D., of the University of Texas Medical Branch, Galveston, Texas, and colleagues conducted the study to determine 30-day readmission rates and factors related to readmission for patients receiving postacute inpatient rehabilitation.

Highlights of the study included:

  >>  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 report 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," according to the report.

"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.”

The study included records for 736,536 Medicare fee-for-service beneficiaries discharged from 1,365 inpatient rehabilitation facilities to the community between 2006 and 2011. The mean age was 78. Sixty-three percent of patients were women, and 85.1% were non-Hispanic white.


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