Advertisement

Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation

Published:August 09, 2017DOI:https://doi.org/10.1016/j.apmr.2017.07.008

      Abstract

      Objective

      To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs).

      Design

      Observational design.

      Setting

      Inpatient rehabilitation facilities.

      Participants

      Medicare fee-for-service beneficiaries (N=567,850 patient-stays).

      Interventions

      Not applicable.

      Main Outcome Measures

      The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission.

      Results

      The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%±3.5%, and the mean risk-standardized readmission rate was 13.1%±0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0±8.6 days and varied by rehabilitation diagnosis.

      Conclusions

      Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates.

      Keywords

      List of abbreviations:

      CMS (Centers for Medicare & Medicaid Services), FFS (fee-for-service), IRF (inpatient rehabilitation facility), MA (Medicare Advantage), PPS (prospective payment system), QRP (Quality Reporting Program), RSRR (risk-standardized readmission rate), SRR (standardized risk ratio)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jencks S.F.
        • Williams M.V.
        • Coleman E.A.
        Rehospitalizations among patients in the Medicare fee-for-service program.
        N Engl J Med. 2009; 360: 1418-1428
        • Medicare Payment Advisory Commission
        Report to the Congress: promoting greater efficiency in Medicare. Chapter 5: Payment policy for inpatient readmissions.
        Medicare Payment Advisory Commission, Washington (DC)2007: 103-120
        • Friedman B.
        • Basu J.
        The rate and cost of hospital readmissions for preventable conditions.
        Med Care Res Rev. 2004; 61: 225-240
        • Goldfield N.I.
        • McCullough E.C.
        • Hughes J.S.
        • et al.
        Identifying potentially preventable readmissions.
        Health Care Financ Rev. 2008; 30: 75-91
        • van Walraven C.
        • Jennings A.
        • Forster A.J.
        A meta-analysis of hospital 30-day avoidable readmission rates.
        J Eval Clin Pract. 2012; 18: 1211-1218
        • Robert Wood Johnson Foundation
        The revolving door: a report on U.S. hospital readmissions.
        (Available at:) (Accessed March 31, 2017)
        • Naylor M.D.
        • Aiken L.H.
        • Kurtzman E.T.
        • Olds D.M.
        • Hirschman K.B.
        The care span: the importance of transitional care in achieving health reform.
        Health Aff (Millwood). 2011; 30: 746-754
        • Naylor M.D.
        • Brooten D.
        • Campbell R.
        • et al.
        Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial.
        JAMA. 1999; 281: 613-620
        • Medicare Payment Advisory Commission
        Report to the Congress: Medicare payment policy. Chapter 7: Medicare's post-acute care: trends and ways to rationalize payments.
        Medicare Payment Advisory Commission, Washington (DC)2015: 159-177
        • U.S. Department of Health and Human Services
        Patient Protection and Affordable Care Act, Section 3004 of 2010.
        (Available at:) (Accessed March 31, 2017)
      1. Medicare program: inpatient rehabilitation facility prospective payment system for Federal fiscal year 2015, 79 Fed Regist, 45915 (Aug 6, 2014).

        • Stucki G.
        • Bickenbach J.
        • Gutenbrunner C.
        • Melvin J.
        Rehabilitation: the health strategy of the 21st century.
        J Rehabil Med. Jan 31 2017; ([Epub ahead of print])
        • Medicare Payment Advisory Commission
        Report to the Congress: Medicare payment policy. Chapter 9: Inpatient rehabilitation facility services.
        Medicare Payment Advisory Commission, Washington (DC)2016: 237-269
        • Ottenbacher K.J.
        • Karmarkar A.
        • Graham J.E.
        • et al.
        Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients.
        JAMA. 2014; 311: 604-614
        • Medicare Payment Advisory Commission
        Report to the Congress: Medicare payment policy. Chapter 10: Inpatient rehabilitation facility services.
        Medicare Payment Advisory Commission, Washington (DC)2013: 215-233
        • Slocum C.
        • Gerrard P.
        • Black-Schaffer R.
        • et al.
        Functional status predicts acute care readmissions from inpatient rehabilitation in the stroke population.
        PLoS One. 2015; 10: e0142180
        • Ottenbacher K.J.
        • Graham J.E.
        • Ottenbacher A.J.
        • et al.
        Hospital readmission in persons with stroke following postacute inpatient rehabilitation.
        J Gerontol A Biol Sci Med Sci. 2012; 67: 875-881
        • Ottenbacher K.J.
        • Smith P.M.
        • Illig S.B.
        • Linn R.T.
        • Fiedler R.C.
        • Granger C.V.
        Comparison of logistic regression and neural networks to predict rehospitalization in patients with stroke.
        J Clin Epidemiol. 2001; 54: 1159-1165
        • Ottenbacher K.J.
        • Smith P.M.
        • Illig S.B.
        • Fiedler R.C.
        • Gonzales V.
        • Granger C.V.
        Characteristics of persons rehospitalized after stroke rehabilitation.
        Arch Phys Med Rehabil. 2001; 82: 1367-1374
        • RTI International
        Measure specifications, NQF #2502.
        (Available at:) (Accessed March 31, 2017)
        • Horowitz L.
        • Partovian C.
        • Lin Z.
        • et al.
        Hospital-wide all-cause risk-standardized readmission measure: measure methodology report.
        Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation, New Haven2011
        • Centers for Medicare & Medicaid Services
        Measure methodology.
        (Available at:) (Accessed March 31, 2017)
        • Pope G.C.
        • Kautter J.
        • Ellis R.P.
        • et al.
        Risk adjustment of Medicare capitation payments using the CMS-HCC model.
        Health Care Financ Rev. 2004; 25: 119-141
        • Pope G.C.
        • Ellis R.P.
        • Ash A.S.
        • et al.
        Principal inpatient diagnostic cost group model for Medicare risk adjustment.
        Health Care Financ Rev. 2000; 21: 93-118
        • Hoyer E.H.
        • Needham D.M.
        • Atanelov L.
        • Knox B.
        • Friedman M.
        • Brotman D.J.
        Association of impaired functional status at hospital discharge and subsequent rehospitalization.
        J Hosp Med. 2014; 9: 277-282
        • Hoyer E.H.
        • Needham D.M.
        • Miller J.
        • Deutschendorf A.
        • Friedman M.
        • Brotman D.J.
        Functional status impairment is associated with unplanned readmissions.
        Arch Phys Med Rehabil. 2013; 94: 1951-1958
        • Yale New Haven Health Services Corporation
        • Center for Outcomes Research and Evaluation
        2016 all-cause hospital-wide measure updates and specifications report.
        Centers for Medicare & Medicaid Services, Baltimore2016
        • Smith L.
        • West S.
        • Coots L.
        • et al.
        Skilled Nursing Facility Readmission Measure (SNFRM) NQF #2510: all-cause risk-standardized readmission measure technical report.
        American Association of Directors of Nursing Services, Denver2015
      2. Medicare program: inpatient rehabilitation facility prospective payment system for Federal fiscal year 2014, 78 Fed Regist, 47906-47910 (Aug 6, 2013).

        • Centers for Medicare & Medicaid Services
        Inpatient rehabilitation facility (IRF) compare.
        (Available at:) (Accessed March 31, 2017)
        • Centers for Medicare & Medicaid Services
        Readmissions Reduction Program (HRRP).
        (Available at:) (Accessed March 31, 2017)
        • Centers for Medicare & Medicaid Services
        ESRD Quality Incentive Program.
        (Available at:) (Accessed March 31, 2017)
        • Centers for Medicare & Medicaid Services
        The Skilled Nursing Facilty Value-Based Purchasing Program (SNFVBP).
        (Available at:) (Accessed March 31, 2017)
        • Medicare Payment Advisory Commission
        Report to the Congress: Medicare payment policy. Chapter 12: The Medicare advantage program: status report.
        Medicare Payment Advisory Commission, Washington (DC)2016: 327-365
        • Kumar A.
        • Karmarkar A.M.
        • Graham J.E.
        • et al.
        Comorbidity indices versus function as potential predictors of 30-day readmission in older patients following postacute rehabilitation.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 223-228
      3. Medicare program: inpatient rehabilitation facility prospective payment system for Federal fiscal year 2017, 81 Fed Regist, 52108 (Aug 5, 2016).

      4. Medicare program: inpatient rehabilitation facility prospective payment system for Federal fiscal year 2017, 81 Fed Regist, 52111 (Aug 5, 2016).

        • Kramer A.
        • Lin M.
        • Fish R.
        • Min S.
        • Providigm L.L.C.
        Development of inpatient rehabilitation facility quality measures: potentially avoidable readmissions, community discharge, and functional improvement.
        Medicare Payment Advisory Commission, Washington (DC)2015