A new study reports that a variety of factors, including several linked to socio-economic status, account for 58 percent of the variation in the rate of Medicare hospital readmissions at the county level.

iStock_000001497717XSmallAmong those factors are low employment, living alone, inability to afford care, the supply of primary care providers and specialists, access to post-discharge nursing home care, and more.

The study found that

The evidence shows that after accounting for patient-risk factors (done by the risk- standardization of the publicly reported rates) and community socioeconomic factors (such as income and employment levels), as well as accounting for hospital characteristics and location, a substantial amount of the variation in readmission rates is explained by local health-system characteristics related to primary care access and the quality of nursing homes. These findings have significant implications on how health care leaders, payers, and policy makers should conceptualize the level of accountability for excess readmissions. The current readmission reduction program that aims to penalize hospitals whose readmissions are above a certain threshold may not be appropriate (Centers 2012). Instead, other payment methods such as those being tested in the Community-based Care Transitions Program (Community 2012), where community-based organizations receive a bundle payment to cover the costs of services required in the postacute care transition period, might be more effective.

It also concluded that

… hospital readmission rates might be more effectively reduced if community-based readmission reduction strategies are added to ongoing, hospital-focused improvement efforts.

This has long been the contention of the National Association of Urban Hospitals:  that social determinants of health make the kinds of low-income Medicare patients private safety-net hospitals serve more difficult to treat, contribute to higher readmission rates than the typical hospital, and need to be reflected in appropriate risk adjustment for Medicare’s hospital readmissions reduction program.

The study, from Health Research Services, is titled “Community Factors and Hospital Readmission Rates” and can be found here.