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Facility Rates of Hospital Readmissi...

Brandeis University, The Heller School for Social Policy and Management., The Heller School for Social Policy and Management.

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Facility Rates of Hospital Readmission Following Discharge from Post-Acute Rehabilitation.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Facility Rates of Hospital Readmission Following Discharge from Post-Acute Rehabilitation./
Author:	Daras, Laura Coots.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2018,
Description:	99 p.
Notes:	Source: Dissertations Abstracts International, Volume: 79-11, Section: B.
Contained By:	Dissertations Abstracts International79-11B.
Subject:	Social research. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=10791294
ISBN:	9780355954692

Facility Rates of Hospital Readmission Following Discharge from Post-Acute Rehabilitation.
Daras, Laura Coots.

Facility Rates of Hospital Readmission Following Discharge from Post-Acute Rehabilitation. - Ann Arbor : ProQuest Dissertations & Theses, 2018 - 99 p.

Source: Dissertations Abstracts International, Volume: 79-11, Section: B.

Thesis (Ph.D.)--Brandeis University, The Heller School for Social Policy and Management, 2018.

This item must not be sold to any third party vendors.

Hospital readmissions for Medicare beneficiaries are common and expensive. Given that over 40 percent of Medicare Fee-for-Service (FFS) beneficiaries receive post-acute care (PAC) following hospital discharge, monitoring hospital readmissions among PAC is essential towards evaluating quality of care. Inpatient rehabilitation facilities (IRFs) are an institutional PAC provider where hospital readmissions are of growing policy focus. The Centers for Medicare & Medicaid Services (CMS) identified readmissions after IRF discharge as one area for quality measurement and began publicly reporting all-cause hospital readmission rates in late 2017. This three-paper dissertation addresses key policy issues related to public reporting of IRFs' hospital readmission rates using inpatient claims and other administrative data sources for Medicare beneficiaries discharged in 2013-2014 from all IRFs nationally. Each study aim aligns with the following three papers: the first paper assesses variation in IRFs' hospital readmission rates by organizational characteristics and geographic region; the second paper explores whether IRFs' hospital readmission rates are associated with Medicare revenue margins; and the third paper summarizes the development of a stroke-specific hospital readmission measure and analyzes variation. Main results from the first paper show that there is substantial geographic variation in IRFs' readmission rates, after controlling for organizational characteristics and practice patterns. In addition, for-profit IRFs have significantly higher readmission rates compared to not-for-profit IRFs. Results from the second paper revealed wide variation in Medicare margins and a positive relationship between Medicare margins and risk-adjusted hospital readmission rates, even after controlling for organizational characteristics. Results from the third paper demonstrated the feasibility of measuring risk-adjusted readmission rates for a stroke-cohort and showed little variation in readmission rates by organizational characteristics, in contrast to the results from first paper. Findings from this dissertation demonstrate significant variation in the quality of care provided by IRFs, as measured by risk-standardized all-cause hospital readmission rates following IRF discharge. However, there was less variation in stroke-cohort readmission rates by organizational characteristics. Lastly, the finding that IRFs with higher Medicare margins have higher hospital readmission rates warrants additional research as it suggests there may be improper incentives. Results from this dissertation provide important information for policymakers and providers, particularly as CMS programs increasingly utilize hospital readmission rates for public reporting and other initiatives tied to Medicare payment.

ISBN: 9780355954692Subjects--Topical Terms:

2122687
Social research.
Subjects--Index Terms:

Inpatient rehabilitation

Facility Rates of Hospital Readmission Following Discharge from Post-Acute Rehabilitation.
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300 $a 99 p.
500 $a Source: Dissertations Abstracts International, Volume: 79-11, Section: B.
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520 $a Hospital readmissions for Medicare beneficiaries are common and expensive. Given that over 40 percent of Medicare Fee-for-Service (FFS) beneficiaries receive post-acute care (PAC) following hospital discharge, monitoring hospital readmissions among PAC is essential towards evaluating quality of care. Inpatient rehabilitation facilities (IRFs) are an institutional PAC provider where hospital readmissions are of growing policy focus. The Centers for Medicare & Medicaid Services (CMS) identified readmissions after IRF discharge as one area for quality measurement and began publicly reporting all-cause hospital readmission rates in late 2017. This three-paper dissertation addresses key policy issues related to public reporting of IRFs' hospital readmission rates using inpatient claims and other administrative data sources for Medicare beneficiaries discharged in 2013-2014 from all IRFs nationally. Each study aim aligns with the following three papers: the first paper assesses variation in IRFs' hospital readmission rates by organizational characteristics and geographic region; the second paper explores whether IRFs' hospital readmission rates are associated with Medicare revenue margins; and the third paper summarizes the development of a stroke-specific hospital readmission measure and analyzes variation. Main results from the first paper show that there is substantial geographic variation in IRFs' readmission rates, after controlling for organizational characteristics and practice patterns. In addition, for-profit IRFs have significantly higher readmission rates compared to not-for-profit IRFs. Results from the second paper revealed wide variation in Medicare margins and a positive relationship between Medicare margins and risk-adjusted hospital readmission rates, even after controlling for organizational characteristics. Results from the third paper demonstrated the feasibility of measuring risk-adjusted readmission rates for a stroke-cohort and showed little variation in readmission rates by organizational characteristics, in contrast to the results from first paper. Findings from this dissertation demonstrate significant variation in the quality of care provided by IRFs, as measured by risk-standardized all-cause hospital readmission rates following IRF discharge. However, there was less variation in stroke-cohort readmission rates by organizational characteristics. Lastly, the finding that IRFs with higher Medicare margins have higher hospital readmission rates warrants additional research as it suggests there may be improper incentives. Results from this dissertation provide important information for policymakers and providers, particularly as CMS programs increasingly utilize hospital readmission rates for public reporting and other initiatives tied to Medicare payment.
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653 $a Rehospitalizations
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