Extending Hospital Stays by One Day Reduces Readmission, Mortality Rates

In 2015, hospital readmissions will be an increasing concern. CMS announced at the beginning of October that more hospitals will be penalized during the third year of its Hospital Readmission Reduction Program. Furthermore, the third year increases the maximum penalty for hospitals to 3% of Medicare payments.

A paper from Columbia Business School researchers published in The National Bureau of Economic Research found that one extra day in the hospital can make all the difference to readmission rates.

The authors analyzed CMS records for more than 6.6 million patients with in-hospital visits between 2008 and 2011 to compare the benefit of 1 extra day in the hospital with outpatient care in terms of readmissions, death rates, and costs.

“Given the stiff penalties imposed under the Affordable Care Act, hospitals are implementing a variety of approaches to aggressively reduce readmission rates, most commonly involving outpatient care,” Ann P. Bartel, professor of finance and economics at Columbia Business School, said in a statement. “While some types of outpatient interventions can be effective, our study shows that hospitals should consider keeping some of their patients in the hospital longer to better control patient care, reduce readmissions and ensure fewer deaths.”

Just one extra day in the hospital can reduce mortality risk by 22% for patients treated for pneumonia and by 7% for heart attack patients compared with outpatient care for Medicare beneficiaries, according to the study. One additional day in the hospital can also decrease readmission rates by 7% for severe heart failure patients.

Overall, they determined that extending a patient’s stay in the hospital by one day could potentially save 5 to 6 times as many lives compared with outpatient programs.

Furthermore, keeping patients an extra day often costs less overall than the associated outpatient care required with early discharge. One-fifth of Medicare patients are readmitted to the hospital within 30 days, which costs taxpayers roughly $17 billion annually, according to the researchers.

“While some outpatient programs can be very effective at reducing hospital readmissions, we find that inpatient interventions can be just as, if not more, effective,” the authors wrote.

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