Changes in Rates of Unscheduled Hospital Readmissions and Changes in Efficiency Following the Introduction of the Medicare Prospective Payment System

The purpose of this study was to analyze changes in rates of unscheduled readmissions and changes in technical efficiency following the introduction of the Medicare Prospective Payment System (PPS). We developed the RiskAdjusted Readmissions Index (RARI), which allowed us to make comparisons in rates of unanticipated readmissions across hospitals and over time. Data envelopment analysis (DEA), a linear programming technique, was used to measure changes in technical efficiency by comparing the inputs used and the outputs produced across a cohort of hospitals, while adjusting for changes over time in case mix and case complexity. Rates of unscheduled readmissions and efficiency scores were computed for a sample of 245 hospitals for each year. Although both readmission rates and efficiency scores increased for most hospitals, there was no evidence that those hospitals that experienced the greatest increases in efficiency had the largest increases in their rates of unscheduled readmissions.

[1]  A Donabedian,et al.  Quality, Cost, and Health: An Integrative Model , 1982, Medical care.

[2]  M. Farrell.  The Measurement of Productive Efficiency , 1957 .

[3]  S. Desharnais,et al.  The early effects of the prospective payment system on inpatient utilization and the quality of care. , 1987, Inquiry : a journal of medical care organization, provision and financing.

[4]  N. Roos,et al.  Centralization, Certification, and Monitoring: Readmissions and Complications After Surgery , 1986, Medical care.

[5]  H. Vuori.  Optimal and Logical Quality: Two Neglected Aspects of the Quality of Health Services , 1980, Medical care.

[6]  C. Zook,et al.  Repeated hospitalization for the same disease: a multiplier of national health costs. , 1980, The Milbank Memorial Fund quarterly. Health and society.

[7]  L L Roos,et al.  Using computers to identify complications after surgery. , 1985, American journal of public health.

[8]  Outcomes of surgery in the Medicare aged population: Rehospitalization after surgery , 1986, Health care financing review.

[9]  C J McDonald,et al.  Nonelective readmissions of medical patients. , 1985, Journal of chronic diseases.

[10]  W. W. Young,et al.  The Measurement of Hospital Case Mix , 1982, Medical care.

[11]  S. Desharnais,et al.  The Effect of PPS on Hospital Product and Productivity , 1987, Medical care.

[12]  J S Gonnella,et al.  Staging of disease. A case-mix measurement. , 1984, JAMA.

[13]  J. J. Holloway,et al.  Factors influencing read mission risk: Implications for quality monitoring , 1989, Health care financing review.

[14]  Abraham Charnes,et al.  Programming with linear fractional functionals , 1962 .

[15]  J. J. Holloway,et al.  Clinical and sociodemographic risk factors for readmission of Medicare beneficiaries , 1988, Health care financing review.

[16]  D. E. Lawrence,et al.  APACHE—acute physiology and chronic health evaluation: a physiologically based classification system , 1981, Critical care medicine.

[17]  S. Zuckerman,et al.  How did Medicare's prospective payment system affect hospitals? , 1987, The New England journal of medicine.

[18]  A. Jette,et al.  Hospital Readmissions Among the Elderly , 1985, Journal of the American Geriatrics Society.

[19]  Jack Hadley,et al.  Profits and fiscal pressure in the prospective payment system: their impacts on hospitals. , 1989, Inquiry : a journal of medical care organization, provision and financing.

[20]  E P Steinberg,et al.  Hospital readmissions in the Medicare population. , 1984, The New England journal of medicine.

[21]  E P Steinberg,et al.  Predicting hospital readmissions in the Medicare population. , 1985, Inquiry : a journal of medical care organization, provision and financing.

[22]  I. Smith,et al.  “Risk” Factors Affecting Readmission of the Elderly Into the Health Care System , 1986, Medical care.