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).
Editors Note: There are over 360
Accountable Care Organizations working with Medicare to provide
higher-quality coordinated care for seniors. Doctors, hospitals and health care
providers establish ACOs to work together to provide better health care, while working to
slow the growth of health care cost.
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
Highlights of the study included:
>> Average rehabilitation length of stay was 12
>> 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
>> 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
The authors report that Medicare is currently
examining bundled payment models designed to improve quality and contain
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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