Age May Play A Role In Readmissions

While thousands of hospitals across the country are losing portions of their Medicare payments due to readmitting patients within 30 days of their initial discharge, a new study by UC San Francisco researchers suggested such penalties for pediatric care may be unwarranted

The study of 958 mostly medium-sized urban hospitals throughout the U.S. that treated pediatric patients concluded their readmission for common medical conditions is not necessarily correlated to the care provided.

The researchers focused on seven common inpatient pediatric conditions – asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders and epilepsy. 

The researchers calculated the rates of readmissions and revisits to the hospital within 30 and 60 days of discharge, broken down by the condition for which they were treated.

For asthma cases – a common healthcare problem among children – only one of the hospitals was better than the rest of the group, while only four performed worse. Among those hospitals treating appendicitis cases, two performed better than average and two performed worse. Among those treating seizures, only one in the entire group performed worse than average.

All of the hospitals in the study had pediatric readmission rates of 5% or less expect in the categories of epilepsy, mood disorders and dehydration. The first two conditions are often unpredictable in their occurrences, while dehydration can occur outside of the inpatient setting for a variety of reasons.

The data for the study was culled from the U.S. Department of Health and Human Services' State Inpatient and Emergency Department databases. 

The researchers concluded that the extremely low number of outliers among pediatric cases is tied to the fact that few children are hospitalized because they're in far better health than adults.

“As a national way of assessing and tracking hospital quality, pediatric readmissions and revisits, at least for specific diagnoses, are not useful to families trying to find a good hospital, nor to the hospitals trying to improve their pediatric care,” said Naomi Bardach, M.D.,  lead author of the study and an assistant professor of pediatrics at UCSF Benioff Children’s Hospital. 

Meanwhile, the Centers for Medicare & Medicaid Services is levying financial penalties on more than 2,200 hospitals over the next year – nearly half the nation's total – due to higher than desired readmission rates for older patients. The nationwide hospital readmission rate was 17.8% for the last half of 2012, down from about 19% over the past five years. 

Healthcare policy experts said the recent drop was tied to the financial penalties that CMS began levying last year, which totaled hundreds of millions of dollars. The agency has released extensive readmissions data for the hospitals, as well as the penalties they are receiving.

Bardach concluded that publishing such data for pediatric care “would waste limited hospital and healthcare resources.”

She and her fellow researchers concluded that it would serve the purposes of gauging a hospital’s quality by looking at their pediatric patients as a group, rather than determining quality on a case-by-case basis.

The study is being published in the latest issue of the journal Pediatrics. It was funded by the National Institutes of Health.