HOSPITALS' TRANSITIONS TO INCREASED OUTPATIENT CARE: IS THERE AN IMPACT ON HOSPITAL-WIDE 30-DAY READMISSIONS? AN ANALYSIS OF DATA FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES, 2014-2023
Author(s)
Denise M. Oleske, PhD1, Mary J. Kwasny, ScD2, Steven C. Landers, BSc3, Richard L. Hughes, MD4, Joseph V. Messer, MD5.
11Global Epidemiology Solutions, Pensacola, FL, USA, 2Northwestern University, Chicago, IL, USA, 36MC, Perth, Australia, 46MC, Middleton, WI, USA, 5Endeavor Health, Evanston, IL, USA.
11Global Epidemiology Solutions, Pensacola, FL, USA, 2Northwestern University, Chicago, IL, USA, 36MC, Perth, Australia, 46MC, Middleton, WI, USA, 5Endeavor Health, Evanston, IL, USA.
OBJECTIVES: Increasing hospital outpatient care may reduce resources available for inpatient care thereby impacting readmission rates, an important secondary endpoint in many clinical trials, quality and patient outcomes studies. This research explores the relationship between the percentage of outpatient revenue to total patient revenue (OPR/TR), as a measure of hospitals’ transition to outpatient care, and hospital-wide 30-day readmission rates.
METHODS: This cohort study included acute care short-term stay hospitals reporting data to the Centers for Medicare and Medicaid Services (CMS) with at least two years of data between January 2014 and December 2023. Publicly available CMS Medicare Provider and Cost Reports were the sources for: provider ID, urban or rural designation, governance, number of acute care beds, Graduate Medical Education (GME) status, disproportionate share percentage, and OPR/TR. CMS Hospital Compare was the source for hospital-wide 30-day readmission rates. Provider ID linked the data across the study years. Mixed linear models were used to estimate the 30-day hospital-wide readmission rates, adjusting for covariates and repeated measures over time.
RESULTS: The study hospital cohort (n=3406) characteristics were: not-for-profit, 62.1%, for-profit, 23.9%, government, 14.0%; urban, 72.8%; GME present, 30.6%. From the first year reported, medians and 25th-75th percentiles for: disproportionate share, 0.126 (0.073, 0.214); OPR/TR, 0.542 (0.432, 0.660); number of acute care beds, 137 (63, 254). Between 2014 and 2023, the adjusted 30-day hospital-wide readmission rates declined from 15.7% to 14.7%; the OPR/TR increased from 56.2% to 63.4%. A significant inverse linear relationship was found between the OPR/TR and the 30-day readmission rates (beta=-0.003, p<0.001), although the strength of the relationship varied by year.
CONCLUSIONS: Hospitals’ increasing transition to outpatient care, measured by OPR/TR, was associated with decreasing adjusted 30-day hospital-wide readmission rates. Readmission rates may change over years. Caution is needed in selecting the referent rate in planning or comparing studies.
METHODS: This cohort study included acute care short-term stay hospitals reporting data to the Centers for Medicare and Medicaid Services (CMS) with at least two years of data between January 2014 and December 2023. Publicly available CMS Medicare Provider and Cost Reports were the sources for: provider ID, urban or rural designation, governance, number of acute care beds, Graduate Medical Education (GME) status, disproportionate share percentage, and OPR/TR. CMS Hospital Compare was the source for hospital-wide 30-day readmission rates. Provider ID linked the data across the study years. Mixed linear models were used to estimate the 30-day hospital-wide readmission rates, adjusting for covariates and repeated measures over time.
RESULTS: The study hospital cohort (n=3406) characteristics were: not-for-profit, 62.1%, for-profit, 23.9%, government, 14.0%; urban, 72.8%; GME present, 30.6%. From the first year reported, medians and 25th-75th percentiles for: disproportionate share, 0.126 (0.073, 0.214); OPR/TR, 0.542 (0.432, 0.660); number of acute care beds, 137 (63, 254). Between 2014 and 2023, the adjusted 30-day hospital-wide readmission rates declined from 15.7% to 14.7%; the OPR/TR increased from 56.2% to 63.4%. A significant inverse linear relationship was found between the OPR/TR and the 30-day readmission rates (beta=-0.003, p<0.001), although the strength of the relationship varied by year.
CONCLUSIONS: Hospitals’ increasing transition to outpatient care, measured by OPR/TR, was associated with decreasing adjusted 30-day hospital-wide readmission rates. Readmission rates may change over years. Caution is needed in selecting the referent rate in planning or comparing studies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD24
Topic
Health Service Delivery & Process of Care
Disease
No Additional Disease & Conditions/Specialized Treatment Areas