With penalties rising in 2015 for hospitals with high Medicare readmission rates, Columbia Business School research offers new evidence that keeping patients in the hospital one day longer can significantly cut readmissions, save patient lives and reduce costs.

The study titled, "Should Hospitals Keep Their Patients Longer? The Role of Inpatient and Outpatient Care in Reducing Readmissions," compares the impact of an extended length of stay in the hospital with the effects of outpatient care for Medicare patients. Researchers found that one additional day in the hospital can:

  • Reduce mortality risk by 22 percent for patients treated for pneumonia
  • Reduce mortality risk by 7 percent for heart-attack patients
  • Result in five-to-six times more lives being saved when compared with outpatient care
  • Decrease readmission rates by 7 percent for severe heart-failure patients 

Additionally, the study showed that one extra day in the hospital would, in many cases, cost less overall than the associated outpatient care required with early discharge. Currently, about one in every five Medicare patients is readmitted to the hospital within 30 days of discharge, costing U.S. taxpayers at least $17 billion annually. 

"Given the stiff penalties imposed under the Affordable Care Act, hospitals are implementing a variety of approaches to aggressively reduce readmission rates, most commonly involving outpatient care," said Ann P. Bartel, professor of finance & economics at Columbia Business School.  "While some types of outpatient interventions can be effective, our study shows that hospitals should consider keeping some of their patients in the hospital longer to better control patient care, reduce readmissions and ensure fewer deaths."

Since the focus of the Affordable Care Act's Hospital Readmissions Reduction Program has been to reduce readmissions of only those patients with heart failure, myocardial infarction or pneumonia, the study focused on these three distinct patient populations.

To learn more about research being conducted at Columbia Business School, please visit www.gsb.columbia.edu.

Study Finds Nationwide Decline in a Type of Serious Heart Attack

The most emergent form of heart attacks is decreasing nationwide, but this declining incidence could affect emergency departments' quality and timeliness of care.

This is the key finding of a Vanderbilt University study released in the American Journal of Cardiology and presented at the national American Heart Association meeting in Chicago.

Using data from the Nationwide Emergency Department Sample, the nation's largest database of information about emergency department visits, the researchers found that approximately 250,000 patients present in emergency departments annually with a specific type of severe heart attack known as a ST-elevation myocardial infarction (STEMI). But, the number of STEMI patients decreased by approximately 30 percent between 2006-2011 in every region of the country and in every age group.

While the nationwide STEMI drop is great news for patients, the authors say this decline makes it difficult for emergency doctors to stay practiced with the most severe and time-sensitive heart attacks.

"If the overall number of severe heart attack patients seen in the emergency department decreases, then health care providers will have less experience caring for these patients, which could lead to delays in recognition for an illness that is highly dependent upon prompt diagnosis and treatment," said lead author Michael Ward, M.D., MBA, assistant professor of Emergency Medicine. "Because of this, it is important that we continue national surveillance on these patients in order to guide health care resource allocation and ensure all of these time-sensitive patients are recognized and treated appropriately."

Senior author Wesley Self, M.D., MPH, assistant professor of Emergency Medicine, added, "Health care has been trying very hard over the last couple of decades to reduce heart attacks, and although more people have cardiovascular disease than ever, the STEMI is declining, which means health care is doing a good job of helping these patients live longer. It looks like heart disease is becoming more of a chronic, lifelong problem instead, with less risk of STEMI and a sudden death, so these patients are going to present in emergency departments differently, perhaps making them more of a ‘needle in a haystack' to pick out and treat."

Ward and Self conducted this research with Sunil Kripalani, M.D., M.Sc., assistant professor of Clinical Medicine; Yuwei Zhu, M.D., M.S., senior associate in Biostatistics; Alan Storrow, M.D., associate professor of Emergency Medicine; Robert Dittus, M.D., MPH, Albert and Bernard Werthan Professor of Medicine; and Frank Harrell Jr., Ph.D., professor and chair of Biostatistics.

This research was funded by the National Heart, Lung and Blood Institute.