Truven Study Finds Return Hospital Visits Linked To Income, Race, Education

ANN ARBOR — A patient’s race, employment status and level of education have a direct impact on hospital 30-day readmissions for heart attack, heart failure, and pneumonia, according to a new study from Truven Health Analytics.

Truven says its scientists analyzed the financial impact of these factors on hospital reimbursement payments from the Centers for Medicare and Medicaid. The analysis found that hospitals that provide a significant amount of care to low-income, uninsured, and vulnerable populations, commonly referred to as Safety-Net Hospitals, as well as many non-safety net hospitals providing care to patients from high need communities, experience higher than average reimbursement penalties.

The study, “CMS Readmission Penalties: Estimating the Impact of
Socioeconomics and Race,” uncovers the key role that community need plays in driving hospital readmissions, and underscores the importance of taking socioeconomic factors into account when evaluating hospital readmission rates.

CMS currently penalizes hospitals for excessive unplanned readmissions within 30 days of patient discharge, using three clinical condition cohorts in its models: acute myocardial infarction (heart attack), heart failure, and pneumonia. A readmissions penalty can be as high as 2 percent of a hospital’s base Medicare reimbursements in 2014. Since the first penalty assessments began in fall 2013, penalties were levied against 2,225 of the nation’s 5,724 hospitals.

Truven Health researchers found that the single socioeconomic factor with the greatest impact on readmission penalties for 30-day, unplanned readmissions for heart attack, heart failure, and pneumonia was employment status. Specifically, high rates of unemployed patients in the treated population reflected up to a 1.3 percent penalty increase for AMI, a 1.1 percent penalty increase for heart failure, and a 1.4 percent penalty increase for pneumonia. These rates trended slightly lower (between 1.1 and 1.2 percent) for race and income, but still reflected an increased likelihood of readmissions.

Most United States hospitals face 15-18 percent readmission rates, Truven said. Further analysis of the underlying data and similar industry studies indicate that up to 12 percent of those readmissions can be avoided. In addition, a recent evaluation conducted by the California insurer Kaiser Permanente suggests that socioeconomic and race related readmissions can be avoided by hospitals with minor accommodations in care management protocol and point of care patient education practices. One Truven Health customer achieved a 50 percent reduction in readmission rates and contributed significant annual savings from preventable readmissions with the additional use of risk-adjusted readmissions benchmarks, real-time surveillance and point of care patient-intervention implementation.

“This research provides clear-cut evidence that socioeconomic factors have a significant impact on readmissions,” said Tina Moen, chief medical officer for provider solutions at Truven. “Without access to a complete analytics model that takes various socioeconomic factors into account across departments, care settings, and care givers, hospitals that are already struggling to deal with disadvantaged community needs could be working at a severe limitation when it comes to closing care management gaps and improving readmission rates.”

The study was based on nationwide hospital discharge data from the CMS Standard Analytical Files. Using statistical modeling, data from third quarter 2009 through second quarter 2012 were used to replicate, to the extent possible, the CMS methodologies for assessing hospital-specific adjusted rates for 30-day, unplanned readmissions for heart attack, heart failure, and pneumonia. Risk-adjustment information for unplanned, 30-day readmissions was produced for all hospitals.

Key findings from the report indicate that the range of adjusted, hospital-wide, 30-day, unplanned readmission rates diminished by almost 10 percent when adjustments for socioeconomic status were included. In light of these findings, Truven Health maintains those factors have a meaningful effect on 30-day hospital readmission rates. Hospitals may be affected differently in that some would see a decline in their adjusted rates; other hospitals would see their
adjusted rates go up, thus increasing their likelihood of receiving a penalty from CMS.

For more information and to read the full study, visit

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