Likelihood of Hospital Readmission after First Discharge

This study tests whether the likelihood of hospital readmission within 30 days of discharge is different for enrollees in Medicare Advantage plans versus the standard fee-for-service program. A key requirement is to control for self-selection into Advantage plans. The study uses statewide inpatient databases maintained by the Agency for Healthcare Research and Quality for five states in 2006. The type of Medicare coverage is known, along with an encrypted patient identifier. We identify eligible first discharges and the first readmission within 30 days. We use selected area characteristics as instrumental variables for enrollment in Advantage plans and apply a bivariate probit analysis. Descriptively, there is a slightly lower likelihood of readmission for Advantage plan enrollees. However, the Advantage plan patients are younger and less severely ill. After risk adjustment and control for self-selection, the enrollees in Advantage plans have a substantially higher likelihood of readmission. Recognizing caveats and limitations, the study supports informing Medicare beneficiaries about the rates of readmission for Advantage plans in their area. Analytical methods to adjust for self-selection into particular plans or plan types should be considered when possible

Actuarial science · Business · Capitation · Capitation fee · Control (management · Economics · Health care · Medicare Advantage · Operations management · Selection (genetic algorithm · Computer Science · Emergency and Acute Care Studies · Finance · Geriatric Care and Nursing Homes · Healthcare Policy and Management · Medicine

• Racial/Ethnic Disparities in Readmissions in US Hospitals

  Open Access•Jayasree Basu, Amresh Hanchate et al.•INQUIRY The Journal of Health…•2018

  Añadir item

• Hospital Revisits Within 30 Days After Conventional and Robotically Assisted Hysterectomy

  Bernard Friedman, Gabriel I Barbash et al.•Medical Care•2016

  Añadir item

• Rehospitalizations among Patients in the Medicare Fee-for-Service Program

  Stephen F Jencks, Malcolm V Williams et al.•New England Journal of Medicine•2009

  Añadir item

• Large Sample Properties of Generalized Method of Moments Estimators

  Lars Peter Hansen•Econometrica•1982

  Añadir item

• Costly Hospital Readmissions and Complex Chronic Illness

  Open Access•Bernard Friedman, H Joanna Jiang et al.•INQUIRY The Journal of Health…•2008

  Añadir item

• Utilization of Services by Chronically Ill People in Managed Care and Indemnity Plans

  Open Access•Stephen M Davidson, Harriet Davidson et al.•INQUIRY The Journal of Health…•2003

  Añadir item

• Health Information Technology and its Effects on Hospital Costs, Outcomes, and Patient Safety

  Open Access•William Encinosa, William E Encinosa et al.•INQUIRY The Journal of Health…•2011

  Añadir item

• Comorbidity Measures for Use with Administrative Data

  Anne Elixhauser, Claudia Steiner et al.•Medical Care•1998

  Añadir item

• Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization

  Kate Lorig, Kate R Lorig et al.•Medical Care•1999

  Añadir item