• Article

Is profit status of inpatient rehabilitation facilities independently associated with 30-Day unplanned hospital readmission for Medicare beneficiaries?

Citation

Li, C-Y., Karmarkar, A., Lin, Y-L., Kuo, Y-F., Ottenbacher, K. J., & Graham, J. E. (2018). Is profit status of inpatient rehabilitation facilities independently associated with 30-Day unplanned hospital readmission for Medicare beneficiaries? Archives of Physical Medicine and Rehabilitation, 99(3), 598-602.e2. DOI: 10.1016/j.apmr.2017.09.002

Abstract

OBJECTIVE: To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities (IRFs).

DESIGN: Study using 100% Medicare claims data, covering 269,306 discharges from 1094 IRFs between October 2010 and September 2011.

SETTING: IRFs with at least 30 discharges.

PARTICIPANTS: A total number of 1094 IRFs (N=269,306) serving Medicare fee-for-service beneficiaries.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Risk-standardized readmission rate (RSRR) for 30-day hospital readmission.

RESULTS: Profit status was the only provider-level IRF characteristic significantly associated with unplanned readmissions. For-profit IRFs had a significantly higher RSRR (13.26±0.51) than did nonprofit IRFs (13.15±0.47) (P<.001). After controlling for all other facility characteristics (except for accreditation status because of its collinearity with facility type), for-profit IRFs had a 0.1% point higher RSRR than did nonprofit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (type III test, P=.005 for both).

CONCLUSIONS: Our findings support the inclusion of profit status on the IRF Compare website (a platform including IRF comparators to indicate quality of services). For-profit IRFs had a higher RSRR than did nonprofit IRFs for Medicare beneficiaries. The South had a higher RSRR than did other regions. The RSRR difference between for-profit and nonprofit IRFs could be due to the combined effects of organizational and regional factors.