Geographic region and profit status drive variation in hospital readmission outcomes among inpatient rehabilitation facilities in the United States

Abstract

OBJECTIVE: To examine whether there are differences in inpatient rehabilitation facilities (IRFs') all-cause, 30-day post-discharge hospital readmission rates by organizational characteristics and geographic regions.

DESIGN: Observational study.

SETTING AND PARTICIPANTS: We analyzed Medicare claims and administrative data sources for Medicare fee-for-service beneficiaries discharged from all IRFs nationally (N=1,166) in 2013 and 2014.

MAIN OUTCOME MEASURE: We applied specifications for an existing quality measure adopted by CMS for public reporting that assesses all-cause unplanned hospital readmissions for 30 days post-discharge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, and state).

RESULTS: The mean IRF risk-standardized hospital readmission rate was 13.00 percent (SD 0.77). After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates compared to not-for-profit IRFs (p<0.001). We also found geographic variation: IRFs in the South Atlantic and South Central census regions had the highest hospital readmission rates compared to IRFs in New England that had the lowest rates.

CONCLUSIONS: Our findings point to variation in the quality of care, as measured by risk-standardized hospital readmission rates following IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions and follow-up.