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Blog: Socio-economic factors impact hospital readmissions

Socio-economic factors such as income, race, gender and age can predict whether a patient will be readmitted within 30 days of discharge from a hospital, according to a study.

Findings from an analysis published Thursday in the Journal of Healthcare Quality suggests women who had been treated for a heart attack had a 17% higher risk than men for being readmitted within 30 days, while the odds of 30-day readmission among Medicare heart attack patients was 24% higher than patients with commercial insurance.

Hospital readmissions have been a contentious topic for providers since the CMS began in 2012 to impose penalties for facilities found to have excessive 30-day readmissions. It was an incentive to improve quality and reduce avoidable hospital expenses.

Critics of the policy contend the program puts a particularly high burden on hospitals that serve low-income communities, where socio-economic factors such as poverty, crime and unstable housing have contributed to higher rates of chronic conditions such as diabetes, heart disease, stroke, cancer and hypertension.

According to the study, patients with lower incomes were more likely to be readmitted than patients in higher-income communities. Previous findings have shown hospitals that serve predominately low-income people are more likely to be penalized by the CMS. Some say that prevents already-struggling facilities to make the necessary investment needed to improve.

“If you're being penalized at a very high level for something that you can't fully control, it's not a fair comparison,” said Blair Childs, senior vice president of Public Affairs for Premier Inc., which conducted the study.

In addition to socio-economic status, the analysis identified the top five conditions that had the highest risks for 30-day admission:
  • Heart failure (20%)
  • Chronic obstructive pulmonary disease (18%)
  • Renal failure (17%)
  • Sepsis (17%)
  • Pneumonia (12%)
The study aims to call attention to the current quality metric system's inequities and to help hospitals identify some key patient factors that could drive readmissions.

“This research highlights areas providers should be paying extra attention to and demonstrates that meaningful risk-adjusted readmission rates can be tracked in a dynamic database,” said study co-author John Martin, Premier's vice president of research operations. He said it's essential to focus efforts that prevent readmissions and adjust payment penalties for vulnerable patient populations.

There's growing recognition of how health disparities impact quality metrics. On Thursday, the CMS released an interactive map that helps identify how community and ethnicity affect disparities among Medicare beneficiaries.

In January, the CMS Innovation Center announced that it would explicitly test whether addressing the social conditions that affect health can lower healthcare costs and improve the quality of care.


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