Health disparities disproportionately drive hospital readmissions

Health disparities, as opposed to medical treatments, are disproportionately driving hospital readmission rates, resulting in higher penalties for safety net hospitals, according to a study published in the journal Surgery.  

Elizabeth Hechenbleikner, MD, MedStar Georgetown University Hospital, et al., studied readmissions after colorectal surgery. The authors evaluated outcomes and patient factors in more than 168,000 colorectal surgery patients treated in 374 California hospitals from 2004-2011, using the State Inpatient Database and American Hospital Association Hospital Survey data. They performed sequential logistic regression analyses to determine the associations between minority-serving hospital status and readmissions.

As noted by MedPage Today, 30-day, 90-day, and repeated readmission rates in minority-serving/safety net hospitals were 13.6%, 20.1%, and 4%, respectively. In comparison, the overall readmission rates were 11.6%, 17.4%, and 3%, respectively.

Patient-level factors, such as race, income, and insurance status accounted for up to 65% of the increase in odds for readmission at minority-serving hospitals.

On the other hand, hospital-level factors, such as procedure volume and procedure type, accounted for up to 40% of the increase. Notably, inpatient mortality was also significantly higher at minority-serving hospitals (4.9%) compared to non-minority-serving hospitals (3.8%).

Study co-author Waddah B. Al-Refaie, MD, also of MedStar Georgetown University Hospital, said in an accompanying statement that CMS holds all hospitals to the same readmission standard.

CMS established the Hospital Readmission Reduction Program (HRRP) in 2012 in an attempt to reduce higher-than-expected readmission rates for six conditions: heart attacks, heart failure, pneumonia, COPD, and hip and knee replacement. “To date, it has penalized more than half of the nation’s hospitals for failing to meet expectations, imposing more than $500 million in fines,” Al-Refaie says.

“These findings suggest that CMS should account for patient socio-economic factors when they compare readmission rates,” he says. If patient-level 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.”

In addition, the study authors highlight the need for addressing patient-level factors in order to “shape quality improvement interventions to decrease readmissions.”

Indeed, some part of the system has to be concerned about addressing these social determinants of health. Instead of pointing to “unfair” fines for safety net hospitals, these hospitals would serve patients better by addressing the readmissions themselves.

For example, hospitals could partner with local community health organizations to help address these patients’ socioeconomic factors and work to find ways to ensure patients are actually recovering well from surgery, and therefore do not need to be readmitted.