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Increased nurse staff levels tied to lower odds of Medicare readmissions penalties, study says



Nursing unions wanting higher staffing ratios have more ammunition thanks to a new study concluding that increasing nurse staffing levels could help hospitals avoid Medicare penalties for avoidable readmissions.

The study covered readmissions of Medicare patients who suffered heart attacks, heart failure or pneumonia. It appears in the October issue of Health Affairs.

The researchers, led by Matthew McHugh, an associate professor at the University of Pennsylvania School of Nursing, looked at nurse staffing levels and readmission data from 2,826 hospitals. They found that hospitals with high nurse staff levels, as considered by researchers, had 25% lower odds of being penalized compared to facilities with lower nurse-staffing ratios. Higher-nurse staffed hospitals also had 41% lower odds of receiving the maximum penalty for readmissions. The study used American Hospital Association staffing data for the study.The research team estimated that each additional nurse hour per patient day brought 10% lower odds of receiving penalties from the Hospital Readmissions Program, the federal effort that started in October 2012 and aimed to reduce the $15 billion in annual Medicare expenditures on preventable readmissions. Hospitals paid about $280 million in penalties for preventable readmissions in fiscal 2013.

“Our findings highlight a component of the hospital care delivery system that can be targeted to limit hospitals' exposure to readmissions penalties while improving patient outcomes,” the authors wrote. “By focusing on a system factor such as nurse staffing, administrators may be able to address multiple quality issues while reducing their likelihood of penalty for excess readmissions.”

In a news release, McHugh said nurses are responsible for many activities associated with reducing readmissions, including coordinating care, overseeing care in the hospital, planning for patients' discharge from the hospitals, and educating patients and their families about what to do when they return home. “It's rather intuitive that when they have adequate staffing and resources to carry out these activities properly, readmission rates decline. This study strongly supports the idea that nurse staffing is one key component of healthcare delivery that hospitals can address to both improve patient outcomes and reduce the likelihood of being penalized for excessive readmissions.”

Increased staffing levels have long been a goal for nursing unions. The National Nurses United, the country's largest nurses union, has launched initiatives in several states to convince state lawmakers to adopt legislation that would establish minimum patient-nurse staffing ratios. The American Nurses Association, a teaching organization, supports the need for federal legislation for staffing ratios, while the AHA opposes such mandatory ratios.

Follow Ashok Selvam on Twitter: @MH_aselvam

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