Hospitals with higher numbers of patients who simultaneously qualify for both Medicare and Medicaid have worse readmissions rates and are therefore more likely to be penalized for readmissions, according to a report in Health Services Research.
The analysis considered Medicare inpatient claims from 2009. It found that dually eligible Medicare/Medicaid beneficiaries are far more likely to live in nursing homes and more than 50 percent have annual incomes under $10,000. In addition, Medicare and Medicaid spent an average of five times more for dual eligibles than for other beneficiaries, suggesting dually eligible individuals often require more care and may have an inherently higher propensity for readmission.
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Because dually eligible patients were more likely to be readmitted within 30 days than non-dually eligible patients (heart attack: 24.3 percent vs. 18. 7 percent, pneumonia: 20.1 percent vs. 17.3 percent, heart failure: 27.4 percent vs. 23.7 percent), the report also found hospitals treating a higher proportion of dually eligible patients were more likely to be penalized for high readmissions rates.
Additionally, a hospital's proportion of dually eligible patients was an independent predictor of any patient's chance of readmission, whether or not that individual was a dually eligible beneficiary.
The report suggests readmissions for dually eligible patients may be due to factors other than quality of inpatient care, so hospitals with high proportions of dually eligible patients may have a somewhat limited ability to reduce readmissions rates and avoid penalties.
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