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For-Profit Hospital Status and Rehospitalizations at Different Hospitals: An Analysis of Medicare Data

Amy J.H. Kind, MD; Christie Bartels, MD; Matthew W. Mell, MD; John Mullahy, PhD; and Maureen Smith, MD, MPH, PhD
[+] Article, Author, and Disclosure Information

From University of Wisconsin School of Medicine and Public Health and William S. Middleton Veterans Affairs Hospital–Geriatric Research Education and Clinical Center, Madison, Wisconsin, and Stanford University, Stanford, California.

Acknowledgment: The authors thank University of Wisconsin Health Innovation Program staff Robert Purvis for data management and variable creation and Colleen Brown for manuscript formatting.

Grant Support: By the University of Wisconsin (UW) Hartford Center of Excellence in Geriatrics; the UW Health Innovation Program; a KL-2 grant from the National Center for Research Resources, National Institutes of Health (1KL2RR025012-01) through the Institutional Clinical and Translational Science Award (UW-Madison) program (1UL1RR025011 to Dr. Kind); and the Community–Academic Partnerships core of the UW Institute for Clinical and Translational Research.

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1159.

Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Kind (e-mail, ajk@medicine.wisc.edu). Data set: Available for purchase through the CMS Chronic Condition Data Warehouse Web site at http://ccwdata.org/index.php.

Requests for Single Reprints: Amy J.H. Kind, MD, William S. Middleton Veterans Affairs Hospital–Geriatric Research Education and Clinical Center, 2500 Overlook Terrace, Madison, WI 53705; e-mail, ajk@medicine.wisc.edu.

Current Author Addresses: Dr. Kind: William S. Middleton Veterans Affairs Hospital–Geriatric Research Education and Clinical Center, 2500 Overlook Terrace, Madison, WI 53705.

Dr. Bartels: University of Wisconsin School of Medicine and Public Health, Rheumatology, University of Wisconsin Medical Foundation Centennial Building, Room 4132, 1685 Highland Avenue, Madison, WI 53705.

Dr. Mell: Stanford University, 300 Pasteur Drive, Suite 3600, Stanford, CA 94305.

Dr. Mullahy: University of Wisconsin School of Medicine and Public Health, Warf Office Building, Room 787, 610 Walnut Street, Madison, WI 53726.

Dr. Smith: University of Wisconsin School of Medicine and Public Health, Room 210-31, 800 University Bay Drive, Madison, WI 53705.

Author Contributions: Conception and design: A.J.H. Kind, C. Bartels, M. Smith.

Analysis and interpretation of the data: A.J.H. Kind, C. Bartels, M.W. Mell, J. Mullahy, M. Smith.

Drafting of the article: A.J.H. Kind.

Critical revision of the article for important intellectual content: A.J.H. Kind, C. Bartels, M.W. Mell, J. Mullahy, M. Smith.

Final approval of the article: A.J.H. Kind, C. Bartels, M.W. Mell, J. Mullahy, M. Smith.

Statistical expertise: A.J.H. Kind, J. Mullahy.

Obtaining of funding: A.J.H. Kind, M. Smith.

Collection and assembly of data: A.J.H. Kind, M. Smith.

Ann Intern Med. 2010;153(11):718-727. doi:10.7326/0003-4819-153-11-201012070-00005
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Background: About one quarter of rehospitalized Medicare patients are admitted to hospitals different from their original hospital. The extent to which this practice is related to for-profit hospital status and affects payments and mortality is unknown.

Objective: To describe and examine predictors of and payments for rehospitalization at a different hospital among Medicare patients rehospitalized within 30 days at for-profit and nonprofit or public hospitals.

Design: Cohort study of patients discharged and rehospitalized from January 2005 to November 2006.

Setting: Medicare fee-for-service hospitals throughout the United States.

Participants: A 5% random national sample of Medicare patients with acute care rehospitalizations within 30 days of discharge (n = 74 564).

Measurements: 30-day rehospitalizations at different hospitals and total payments or mortality over the subsequent 30 days. Multivariate logistic and quantile regression models included index hospital for-profit status, discharge counts, geographic region, rural–urban commuting area, and teaching status; patient sociodemographic characteristics, disability status, and comorbid conditions; and a measure of risk adjustment.

Results: 16 622 patients (22%) in the sample were rehospitalized at a different hospital. Factors associated with increased risk for rehospitalization at a different hospital included index hospitalization at a for-profit, major medical school–affiliated, or low-volume hospital and having a Medicare-defined disability. Compared with patients rehospitalized at the same hospital, patients rehospitalized at different hospitals had higher adjusted 30-day total payments (median additional cost, $1308 per patient; P < 0.001) but no statistically significant differences in 30-day mortality, regardless of index hospital for-profit status.

Limitation: The database lacked detailed clinical information about patients and did not include information about specific provider practice motivations or the role of patient choice in hospitalization venues.

Conclusion: Rehospitalizations at different hospitals are common among Medicare patients, are more likely among those initially hospitalized at a for-profit hospital, and are related to increased overall payments without improved mortality.

Primary Funding Source: University of Wisconsin Hartford Center of Excellence in Geriatrics, National Institutes of Health.


Grahic Jump Location
Study flow diagram.

POS = provider of services.

* For patients with more than 1 qualifying hospitalization–rehospitalization dyad, only the first chronologically was included.

Grahic Jump Location




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