DSH Hospitals More Prone to Readmissions Following Cancer Surgery

Hospitals that serve the more vulnerable population perform worse with their readmission rate, and the subsequent penalties that they face can further strain the hospital’s already burdened finances. These are the conclusions from a new study, published online in the Journal of the American College of Surgeons, which evaluated the readmission rate in patients following cancer surgery.

Nearly 110,900 patients who underwent complex surgeries for their cancer—between January 1, 2004, and September 30, 2011, in California—were identified. Vulnerable hospitals were defined as either self-identified safety net hospitals (SNH) or hospitals with high percentage of Medicaid patients (high Medicaid hospitals, HMH). Of the 355 hospitals that were included in the analysis, 13 were SNH and 31 were HMH. After adjusting for Hospital Readmissions Reduction Program (HRRP) variables, the study found that:

• 30-day readmission rates were 14% for SNH, 13% for HMH, and 14% for safety net and high Medicaid institutions.
• 90-day readmission rates were 20% for SNH, 22% for HMH, and 21% for high Medicaid and safety net hospitals.
• Readmission rates for non-vulnerable hospitals were 11% at 30 days and 17% at 90 days.

Further, with respect to patient demographics, patients who were admitted for surgeries in vulnerable hospitals, compared with non-vulnerable hospitals, were:

• More likely to be from low-income neighborhoods (28% vs 17%)
• More likely to be on Medicaid health assistance (27% vs 5%)
• More likely to be admitted via the emergency department for their procedure (15% vs 9%).

Additionally, HMH hospitals saw a significantly greater number of patients of Hispanic origin enrolled.

While multiple factors can influence readmission rates, socioeconomic and hospital characteristics bear significant weight. Penalizing hospitals for high readmission rates without understanding these influences can add significant stress on a hospital’s resources. A report released by Kaiser Health News last year found that following inception of the HRRP, readmission rates dropped overall, but 1 in 5 hospitalized Medicare patients were still readmitted to the hospital within 30 days. These numbers underscore the vulnerable nature of hospitals that serve these patients.

“Different hospitals have different patient mixes, and if that is not factored in, HRRP reductions in payment may further marginalize financially vulnerable hospitals,” said corresponding study author Waddah B. Al-Refaie, MD, FACS, chief of surgical oncology, MedStar Georgetown University Hospital, in a press release.

Reference

Hong Y, Zheng C, Hechenbleikner E, et al. Vulnerable hospitals and cancer surgery readmissions: Insights into the unintended consequences of the Patient Protection and Affordable Care Act [published online May 31, 2016]. J Am Coll Surg. doi:http://dx.doi.org/10.1016/j.jamcollsurg.2016.04.042.