Factors often blamed for low readmission rates—socioeconomic status, access to health care, and insurance coverage—do not explain why readmission rates are higher in some hospitals than others, or why dual-eligibility Medicare-Medicaid patients are more likely to be readmitted to hospital, new research shows.
Yale University researchers led a panel that compared readmissions of patients with three major acute conditions covered by both Medicare and Medicaid to those who had only Medicare. article posted on the JAMA Health Forum on Friday.
The findings refute the common explanation for why some hospitals experience more readmissions: institutions that treat a disproportionate proportion of patients with low income, poor health, and other negative circumstances are at a disadvantage relative to similar institutions.
“Inequity in readmission rates for dual entitlement patients is not the main result of differences measurable between communities, highlighting that hospitals can play a special role in ensuring equity for socioeconomically disadvantaged patients,” the authors write.
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Researchers at Yale University, Mathematica Policy Research, Boston’s Brigham and Women’s Hospital, Vertex Pharmaceuticals, and George Washington University first examined the differences in readmission between the dual-entitlement population and those covered by Medicare alone. The discrepancy was striking.
The study took into account census data on three differences that affect patients’ health: access to healthcare services (such as primary care density in the county), state Medicaid policy and coverage, and socioeconomic factors such as unemployment and lack of transportation.
Readmission rates were then adjusted for the 2.5 million patients treated in more than 4,000 hospitals from 2014 to 2017 based on these socioeconomic indicators. After adjusting for factors, there was a modest reduction in readmission rates. But if the reason for readmissions were indeed higher numbers of patients with low socioeconomic status, then there would be no difference in readmission rates for each group of patients.
However, dual criteria patients still had worse readmission rates than their counterparts. The authors conclude that hospitals must close this gap. “Hospitals can reduce these internal disparities by focusing on data collection and analytic resources, culture transformation efforts, and quality improvement activities to strengthen equity in outcomes,” the study says.