Medicare patients at hospitals serving mainly ethnic elders end up back in the hospital within a month of being discharged much more often than patients at mainly white hospitals, according to a new study.
Hospital readmissions within 30 days of discharge—usually because a patient was released too early or without a plan for follow-up care at home—are a $17 billion-a-year problem.
The harm to patients and enormous costs associated with these “unnecessary” or “bounce-back” readmissions led Congress to include programs and penalties aimed at reducing the problem in the Affordable Care Act, aka the health care reform law. According to a 2009 study, two out of three bounce-back readmissions stem from inadequate planning or other avoidable factors for seniors and their families.
The new study by the Harvard School of Public Health, published in the Journal of the American Medical Association (JAMA), analyzed Medicare data for more than 3 million patients at hospitals nationwide.
The researchers compared readmission rates for black and white patients. They also contrasted what happened to older patients who go to mainly white hospitals with those admitted to medical centers where more than one-third of the patients are minorities. The latter accounts for some 10 percent of hospitals nationwide.
Blacks Had Highest Odds of Readmission
“We found that white patients at non-minority-serving hospitals consistently had the lowest odds of readmission and that black patients at minority-serving hospitals, the highest,” wrote lead author Karen E. Joynt, MD.
Overall, black patients stood a 13 percent greater chance of readmission within a month of hospital discharge, Joynt and her colleagues found.
Patients at largely minority hospitals stood a 23 percent greater change of checking back in within 30 days—regardless of their race—than if they’d been in a hospital serving mainly white patients.
“The hospital at which a patient received care appears to be at least as important as his/her race,” Joynt and her co-researchers said.
Experts have long expressed concern about the quality of patient care at medical facilities serving largely ethnic populations. But they cautioned that hospital readmissions are only one indicator of quality care and advised patients not to react to the JAMA study by automatically avoiding such hospitals.
“Many hospitals that serve minorities are very well managed and provide outstanding care on shoestring budgets,” said Carmen Green, MD, who directs the Healthier Black Elders Center for the Michigan Center for Urban African American Aging Research at the University of Michigan medical school. Although the new study raises important questions about minority hospitals, she said, “Don’t be scared to go to them.”
The Harvard research team focused on Medicare patients with three common conditions: heart attacks, congestive heart failure and pneumonia.
Black patients treated for a heart attack at minority-serving hospitals stood a 35 percent greater chance of being readmitted within a month than white patients at mainly white hospitals. White patients at minority hospitals were 23 percent more likely to be readmitted.
But discrepancies persisted even at hospitals serving mainly whites. African Americans treated at mainly white medical centers were 20 percent more likely to end up back in the hospital than whites at the same hospitals. The findings for the other conditions were similar.
About 40 percent of African-American elders in the study were treated at mainly minority facilities, compared with only 6 percent of white Medicare patients.
Don’t Over-Penalize Black Hospitals
Under the health care reform law, hospitals will incur fines for excessive readmissions starting in 2013.
But Joynt and her coauthors cautioned that “minority-serving hospitals might be disproportionately affected by such penalties.”
A JAMA editorial stressed that penalizing hospitals that treat vulnerable populations may actually deepen racial health disparities.
The editorial calls for rewarding hospitals that reduce readmissions, while also setting aside additional funds for hospitals that shoulder the responsibility of caring for vulnerable populations and still improve over time. Simply cutting medical center budgets based on readmission rates might favor more affluent hospitals with greater resources.
The JAMA editorial states, “The consequences of policies that inadvertently reward the rich and penalize the poor must be carefully considered.”
Toni P. Miles, M.D., of the University of Louisville, a leading researcher on racial disparities in health care for seniors, cited research showing that “black-serving institutions basically are starved of the capital needed to provide care.”
Green urged patients—whether considering a hospital that treats mainly whites or mainly minorities—to be proactive by talking with their physicians and checking out the hospital online. One useful new resource is Hospital Compare, created by the U.S. Department of Health and Human Services, which provides information on how well a hospital cares for patients with certain medical conditions or surgical procedures.
Regardless of a hospital’s reputation, Green added, to avoid being sent home too early or being released without an adequate plan for follow-up care at home, patients need to come prepared. This includes doing their homework on their condition and coming to the hospital with a friend or relative who can serve as their advocate, helping to ask questions and navigate through the hospital system.
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