Health disparities are key drivers of readmissions in hospitals treating underserved populations, research shows.
Rather than medical treatments, health disparities disproportionately drive many hospital readmissions, leading to correspondingly high volumes of penalties for hospitals treating large numbers of underserved patients.
Factors such as race, income, and insurance status are large factors in readmissions, according to researchers.
Researchers at MedStar Georgetown University Hospital studied readmissions after colorectal surgery, which has a high risk for postoperative complications and hospital readmissions within 30 days of discharge.
The researchers examined outcomes and patient factors in more than 168,000 colorectal surgery patients treated in 374 California hospitals from 2004-2011.
Forty-seven of these hospitals were considered minority-serving hospitals, treating a high percentage of minority patients. Hispanic and black patients comprise 63% of the patient population in minority-serving hospitals, compared with 17% in other hospitals.
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After accounting for a patient's age, gender, comorbidities, and year and type of procedure, the researchers found that, overall, 30-day, 90-day, and repeated readmission rates were 11.6%, 17.4%, and 3%, respectively.
In comparison, the rates in minority-serving hospitals were 13.6%, 20.1%, and 4%, respectively. Inpatient mortality was also significantly higher at minority-serving hospitals (4.9%) compared to non-minority-serving hospitals (3.8%).
Patient factors (race, low income, and insurance status) accounted for up to 65% of the observed increase in odds for readmission at minority-serving hospitals, the investigators found.
Hospital-level factors (such as procedure volume and procedure type) accounted for up to 40% of the increase.
CMS takes the view that all hospitals should be held to the same readmission standard, noted the study's senior investigator, Waddah B. Al-Refaie, MD, FACS, surgeon-in-chief at Georgetown Lombardi Comprehensive Cancer Center and chief of surgical oncology at (GUH).
That standard comes with a high price: So far, the Hospital Readmission Reduction Program has penalized more than half of the nation's hospitals for failing to meet expectations, imposing more than $500 million in fines to date.
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Writing in the journal Surgery published online Oct. 28, the study's investigators say the federal government should take patient factors into account in their push to reduce hospital readmission rates.
"If these factors are not balanced out, we fear minority-serving hospitals will face substantial, crippling financial penalties, and may end up being selective about the patients they admit," Al-Refaie said in a statement about the study.
"These findings suggest that CMS should account for patient socio-economic factors when they compare readmission rates," he said.
"Minority-serving status of a hospital is important. These hospitals typically serve as a safety net in low-income communities; their patients tend to have more co-morbidities and less resources to support their health."
Safety-net hospitals—those providing healthcare to a large proportion of uninsured and patients with Medicaid—are more commonly penalized under the HRRP program.
"We worry that imposing unfair fines for surgery readmission on hospitals that are already financially vulnerable will have unintended consequences on patients," he says.
"These hospitals may become less inclined to take in sicker patients and reduce spending necessary for patient safety, and that puts more patients' health at risk."