Keeping Patients Hospitalized One More Day Has Multiple Benefits
It turns out that keeping patients in the hospital for just one day longer can saves lives, lower costs and reduce readmissions. That's the conclusion of one study from the Columbia University Business School entitled "Should Hospitals Keep Their Patients Longer?" The study's authors, two professors and a PhD student, found that waiting an extra day to discharge patients can:
- Reduce the mortality risk for pneumonia patients by 22 percent;
- Reduce the mortality risk for heart attack patients by 7 percent;
- Result in five-to-six times more lives being saved compared with outpatient care; and
- Decrease the risk of readmission for severe heart attack patients by 7 percent.
The Columbia University researchers also found that keeping patients in the hospital one day longer often costs less than discharging them and scheduling them for follow-up outpatient care. These findings may be particularly valuable given that the Affordable Care Act imposes stiff penalties for readmissions of Medicare patients with heart failure, acute myocardial infarction or pneumonia.
Those penalties get higher every year. In addition, on Oct. 1, 2014, the Centers for Medicare and Medicaid Services added more conditions to the readmissions penalty list: acute exacerbation of chronic obstructive pulmonary disease; elective total hip arthroplasty; and total knee arthroplasty. In fiscal 2013, about 18 percent of Medicare patients were readmitted to the hospital within 30 days of discharge. That was about two million patients and the cost to Medicare was $26 billion. CMS officials estimated that $17 billion of that was spent on potentially avoidable readmissions. Those readmissions resulted in fines of $428 million, not nearly enough to recoup the costs to taxpayers. Some hospitals have said the penalties for readmissions are unfair because they penalize hospitals for circumstances beyond their control, such as patients' post-discharge behavior.
The Columbia University researchers stated that keeping patients hospitalized for an extra day would help them reach a higher level of stability and would give doctors and nurses more time to educate them about post-discharge behavior. Some of their more detailed findings:
- Letting high-severity heart-failure patients stay in the hospital for one more day decreases their readmission risk by 7 percent.
- Medicare fee-for-service patients are more likely to be readmitted than Medicare Advantage patients are. That's because Medicare Advantage patients have policies with private-sector insurance companies that are reimbursed by Medicare. Medicare may not cover the insurance companies' costs, so the companies have an incentive to reduce readmissions by paying for better primary and outpatient care, the study stated.
- Keeping all pneumonia patients who have Medicare fee-for-service plans in the hospital for an extra day would save 19,063 lives, while switching them to Medicare Advantage would save only 3,177 lives.
The Columbia University study was not the first to examine the relationship between length of hospital stays and readmissions, but it appears to be the first to show a connection between them. One previous study found no relationship. Another study found an increase in readmissions and a decrease in hospital lengths of stay and mortality, but failed to find the two issues were connected. Unlike the others, the Columbia University study focused only on the three conditions that are subject to Medicare readmission penalties -- heart failure, acute myocardial infarction and pneumonia. "To the best of our knowledge, we are the first to explore how hospitals may modify inpatient care as an appropriate and desirable response to the new Medicare penalties," stated the study's authors.