Functional Status, Social Support, and Wealth Affect Readmissions for Pneumonia and Heart Failure Beyond Standard Medicare Risk Adjustors
*Heidi Reichert, University of Michigan
Keywords: CMS, Medicare, Hospital Readmissions Reduction Program, Value-based purchasing, Readmissions, risk-adjusted, risk-adjustment, HRS, Health and Retirement Study
Hospital rates of unplanned Medicare readmissions within 30 days of discharge for pneumonia and heart failure are publicly reported on "Hospital Compare" and used to assess value-based purchasing hospital payments and penalties. These readmission rates are “risk-adjusted,” accounting for age, gender, and medical comorbidities available within Medicare claims data. Using the Health and Retirement Study Medicare-linked data sets (from 1995-2012) and following the published methods used by Centers for Medicare and Medicaid Services for determining risk factors for readmission, we were able to test the hypothesis that patient functional status, social support, and wealth also affect unplanned readmission rates.