Hospitals see lower readmissions with more post-discharge options

Health systems with more primary care doctors and palliative care services saw fewer people coming back to the hospital, a new study finds.

Hospitals providing a variety of post-discharge care options typically enjoyed more success in helping patients avoid readmission, a new study finds.

Researchers found that hospitals with a larger supply of primary care physicians and health systems that offered palliative care services had lower 30-day readmission rates. Health systems operating in areas with more skilled nursing facility beds or licensed nursing home beds also saw fewer people return to the hospital within 30 days. The study was published Tuesday, July 5 in Health Affairs.

However, the study also found hospitals in areas with a larger number of home health agencies or nurse practitioners saw a higher level of 30-day readmissions.

The authors noted that hospitals may want to consider providing additional post-discharge care options to serve their patients and to avoid the prospect of penalties from the federal government. The Centers for Medicare and Medicaid Services reduces payments to healthcare systems if they persistently have higher rates of readmissions.

“Our results suggest that hospitals may take a more active role in the development of postdischarge care options in their communities or partner with existing infrastructure to improve continuity of care and clinical outcomes and to avoid penalties,” the authors wrote.

The authors also suggested hospitals should employ palliative care services where possible.

“Palliative care use may reduce unwanted, potentially unnecessary medical care for seriously ill people, whereas patients in areas without sufficient access to primary care or nursing facilities (for example, isolated rural or low-income urban areas) may be forced to return to hospital emergency departments if complications arise,” the researchers wrote.

Building community partnerships

Researchers examined more than 3,000 hospitals between 2013 and 2019.

Most of the hospitals were private, nonprofit providers based in urban areas, the authors said. Most operated a hospital-based palliative service. The median hospital in the study had fewer than 200 beds and an average daily census of fewer than 100 patients.

Health systems should look for opportunities to work with other community organizations and agencies to help patients after they leave the hospital.

“Our results suggest that hospitals may benefit from work to improve local access to care or hospital-community partnerships to improve continuity of care after discharge,” the authors wrote.

Hospitals should be taking a close look at readmission rates from various discharge sites to determine if patients are faring better in some settings than others and to see where care can be improved.

With higher readmission rates associated with home health agencies, the authors suggest it could be a reflection of a lack of continuity of care due to the high turnover of workers in those agencies.

While a higher rate of nurse practitioners was also associated with a higher likelihood of readmission to the hospital in this study, the authors noted nurse practitioners have shown success in some interventions in helping patients avoid a return trip to the hospital.

The authors speculated that a higher concentration of nurse practitioners in a region may be a sign that patients in that area have a higher level of sickness or health complications, the authors noted. The tie between nurse practitioners and greater readmission rates could also be a reflection of the dearth of other healthcare resources.

Reconsidering penalties

The authors said the study carries implications on how the federal government should be reimbursing hospitals.

CMS should reevaluate some of the ways it examines health systems to determine if they should be penalized under the Hospital Readmissions Reduction Program, the authors suggest.

“CMS may also consider risk adjustment for postdischarge care supply under the HRRP to avoid penalizing or rewarding hospitals based on the characteristics of the communities they serve instead of the quality of care they provide,” the authors wrote.

If CMS adjusts its risk on the availability of a hospital-based palliative care service, it could punish health systems with such services by reducing their readmission targets, the authors said.

Such a move could also deter health systems from launching palliative care services, the authors wrote.

Researchers from Vanderbilt University Medical Center, Veterans Affairs Boston Healthcare System, Washington University in St. Louis, and Boston University wrote the study.