FEATURE: Heart failure readmissions are no higher in safety-net hospitals

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ORLANDO, Fla.—Urban safety-net and non-safety-net hospitals have clinically comparable risk-standardized rates of heart failure (HF) readmission, according to q poster study presented Sunday at the 58th annual American College of Cardiology (ACC) scientific sessions. The authors defined safety-net hospitals as public hospitals or private hospitals with a Medicaid caseload greater than one standard deviation above the states' mean private hospital caseload.

Joseph S. Ross, MD, department of geriatrics and adult development at Mount Sinai School of Medicine in New York City told Cardiovascular Business News that the results "surprised" him and his investigators. "We had anticipated the readmission rates would be slightly higher at the safety-net hospitals, particularly as the economic incentives continue to align toward less reimbursement for the uninsured and underinsured," he said.

For the researchers, the main outcome measure was hospital-specific risk- standardized all-cause readmission within 30 days of discharge after index heart failure hospitalization (RSRR). They performed a cross-sectional analysis of 2006 Medicare Provider Analysis and Review (MedPAR) administrative claims data from all fee-for-service beneficiaries in U.S. acute care hospitals. The cohort included beneficiaries aged at least 65 years hospitalized for heart failure at an urban hospital and discharged alive.

The researchers found that they were 377,508 distinct hospitalizations for heart failure in 2,184 urban hospitals in 2006; 60,212 in 465 safety-net hospitals and 317,296 in 1,719 non-safety-net hospitals. Safety-net hospitals had statistically significant, but clinically insignificant, higher RSRRs when compared with non-safety-net hospitals (24 vs. 23.7 percent).

The authors noted that there was substantial heterogeneity in RSRRs among safety-net and non-safety-net hospitals with extensive overlap in performance.

Based on their findings, Ross and colleagues concluded that the fiscal implications of caring for vulnerable populations has not diminished the quality of care for heart failure hospitalizations at safety-net hospitals as measured by RSRRs.

However, Ross noted that their "non-finding is more a reflection in there being, in general, poor readmission care at all hospitals. Therefore, there is much opportunity for improvement everywhere."