VA’s Shorter Hospital Stays Didn’t Create Higher Readmissions

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By Brenda L. Mooney

WASHINGTON — When it comes to hospital stays, longer is not necessarily better in reducing 30-day readmission rates.

That’s according to a review of records for the more than 4 million patients hospitalized at 129 acute care VA hospitals from 1997 to 2010. For the study, published recently in the Annals of Internal Medicine, investigators from VA’s Health Services Research & Development (HSR&D) service examined trends in hospital length-of-stay (LOS), 30-day readmission rates and 90-day mortality for all medical diagnoses combined, as well as five specific common diagnoses: heart failure, chronic obstructive pulmonary disease (COPD), acute myocardial infarction, community-acquired pneumonia and gastrointestinal hemorrhage.

Their research determined that, while LOS decreased by 27% in adjusted analysis over the time period, the relative readmission rates did not rise. In fact, they decreased by 16%.

Furthermore, all-cause mortality at 30 and 90 days decreased by about 3% annually during the 14-year span.

The greatest LOS reductions over the 14-year period were for acute myocardial infarction, 2.85 days, and community-acquired pneumonia, 2.22 days.

Readmissions, meanwhile, dropped from 22.6% to 19.8% for acute myocardial infarction and 17.9% to 14.6% for COPD.

“This indicates that LOS reductions have not, thus far, adversely affected the likelihood of hospital readmission,” according to the authors.

The VA’s success with lowering LOS can be a valuable example for non-federal hospitals, according to the authors, because, “hospitals are driven to improve efficiency as skyrocketing costs have outpaced reimbursement and face incentives to reduce LOS as part of the Medicare prospective payment system, diagnostic-related group — based third-party payments, and closed system HMO care models.”

Readmission within 30 days can be costly, according to the study background, which notes that, in studies of Medicare patients, 30-day readmission rates range from 8% to 21%, depending on diagnosis, and cost about $17.4 billion annually.

Finding the appropriate length-of-stay can be a delicate balance, however.

The study found that patients with longer LOS also have higher readmission rates—a 3% increase for each additional day of stay—which is likely to be due to unmeasured severity that affects both readmission and LOS.

In addition, “there is emerging concern that excessive length of stay (LOS) reductions may be harmful because discharge before medical stability can result in hospital readmission or use of emergency department services,” according to HSR&D.

Hospitals with mean risk-adjusted LOS lower than the average across all hospitals posted a higher readmission rate, according to the research, with a 6% increased risk for each day lower than expected.

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