Does Shorter LOS Cause a Higher Readmission Rate?
The way Medicare pays hospitals encourages shorter lengths of stay. But could those shorter stays lead to more readmissions? According to a study in JAMA:
60 percent of severe heart attack patients enrolled in the United States were discharged in three days or less, yet 14.5 percent of the U.S. patients required another stay within a month. By comparison, 54 percent of study participants in other countries spent at least six days in the hospital, leading to a 9.9 percent 30-day readmission rate.
When the data were adjusted to account for the length of stay, the difference between U.S. readmission rates and those in other countries was greatly diminished, suggesting that the shorter length of stay in U.S. hospitals impacts readmissions.
I believe it’s safe to argue that shorter length of stay has indeed lead to more readmissions. It’s not rocket science. If the average length of stay after a heart attack was 30 days, almost nobody would ever be readmitted. But when the average falls to three days, a certain number will be readmitted. From this point of view, there is nothing inherently wrong with a few readmissions as long as the average length of stay and average rate of readmissions are both optimal. In other words, the optimal rate of readmission is not 0.
Devon hits the nail on the head in arguing that a balance must be struck.
I view the current balance cited in the article as a good thing. Readmitted patients receive more detailed care and those who can return to good health after 3 days cut their hospital stay in half.
Agreed, this finding is not particularly surprising. There is a happy medium somewhere between keeping patients in the hospital until they are perfectly healthy and discharging them as soon as they are stabilized. Hospitals need to find that point where patient health is maximized and hopefully, costs controlled as well.
It would be fascinating to know how much shorter lengths of stay are for heart patients when occupancy at the hospital is very high compared to those times when occupancy is lower than usual.
There have been two recent posts at this site that show fundamental defects in the DRG system.
First, was a study that found that the DRG system didn’t save money.
Now, we have a study that suggests it may have reduced the quality of care.
Some additional thoughts…
7 day readmission or 30 day readmission?
Are the lower LOS’s associated with high quality outcomes?
While there is an optimal LOS associated with a DRG, there is no reason a shorter LOS can not also have higher quality outcomes.
St. Vincent (Toledo) has presented to the HQA board mtg in June on an acute LOS at 3.8 with a 7 day readmission rate that, at the same time, dropped from 8% to roughly 1% along with a correspondingly dramatic reduction in the 30 day RR.
Is it possible the shorter LOS’s resulting in increased RR’s is a result of shortening the stay without simultaneously increasing the quality of care?