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Shorter hospital stays don't necessarily mean higher readmissions: study


By Maureen McKinney
Posted: December 17, 2012 - 5:15 pm ET
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Hospitals that have grappled with how best to curb length of stay while also preventing readmissions may find comfort in a new study that suggests that a drop in the former does not necessarily mean a greater number of the latter.

Using 14 years of data from 129 Veterans Affairs hospitals, researchers concluded that an overall reduction in risk-adjusted length of stay was not associated with a corresponding spike in 30-day readmission rates, according to the VA-funded study, published Monday in the Annals of Internal Medicine.

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From 1997-2010, overall length of stay for the five conditions examined fell nearly 27%, to 3.98 days from 5.44 days. Meanwhile, 30-day readmission rates for those conditions, including heart failure and heart attack, fell to 13.8% from 16.5%.

Researchers did find, however, that patients who were discharged earlier than expected, given their illness and trends in length of stay, were more likely to be readmitted—indicating the need to identify the right balance between discharging patients too soon and keeping them admitted longer than necessary, they said.

The findings could result from a number of contributing factors, including previous inefficiencies and longer-than-necessary lengths of stay at VA hospitals, the authors said. In addition, they said, the use of medication reconciliation and the use of hospitalists have improved transitions of care and bolstered quality.

The authors also cautioned that programs that target readmissions, such as the CMS' Readmissions Reduction Program, could introduce unintended consequences as providers struggle to avoid financial penalties.

"Instead of reducing or eliminating payment for a readmission, further research is necessary to determine whether readmission costs more or less than the actual index admission and change payment based on the actual cost of care," they wrote.


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