Keeping patients in the hospital one day longer significantly lowered their risk of readmission and mortality, according to a study by researchers from the Columbia University Graduate School of Business.
Medicare announces larger-than-expected outpatient pay bump
The study was designed to address the complaint that hospital readmissions are spurred less by inpatient care and more by post-hospital care. It was released as a working paper by the Nation Bureau of Economic Research.
For the study, the researchers examined Medicare data from 2008 to 2011. Columbia associate professor Carry Chan says, "We wanted to see if this was a lever within the hospitals' control that could also impact and reduce readmissions."
The researchers found that giving patients one extra day in the hospital—rather than releasing them into outpatient care—resulted in:
- A 22% drop in mortality for pneumonia patients;
- A 7% decline in heart attack deaths; and
- A 7% reduction in readmission for heart failure patients.
In addition, they found that the cost of one extra day in the hospital would often be less than the overall cost associated with discharge the patient earlier. However, Chan says it is unclear whether an extra day would be cost-effective for hospitals under existing Medicare payment models. She notes that the cost of the extra day would likely exceed that of a readmissions penalty.
What to know about readmission penalties this year
Some experts saying keeping patients longer could be detrimental
The report notes that "interventions like these have shown mixed results, with limited evidence of success," and many experts remain skeptical that increasing length of stay (LOS) can decrease readmissions.
In fact, Jeremiah Brown, assistant professor of health policy at The Dartmouth Institute, says, "We often see longer length [of stay] associated [with] higher risk patients, higher mortality, and higher readmissions." But Brown acknowledges that the Columbia researchers conducted a "high quality" analysis and says that the findings should be further tested in the era of pay-for-performance.
Amanda Brewster of the Global Health Leadership Institute at Yale University says, "When you see [patients] are less likely to be readmitted, it's hard to chalk that up to a different in length of stay or a difference in outpatient management." However, she adds that readmission penalties could provide caregivers an incentive to "rethink whether the hospital is going to benefit by reducing the length or extending the length of stay to try and reduce those readmissions" (Ready, HealthLeaders Media, 11/4; Bird, FierceHealthcare, 11/2).
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