title: Hospital cost of care, quality of care, and readmission rates: penny wise and pound foolish?
abstract: BACKGROUND
  Hospitals face increasing pressure to lower cost of care while improving quality of care. It is unclear if efforts to reduce hospital cost of care will adversely affect quality of care or increase downstream inpatient cost of care.
  
  
  METHODS
  We conducted an observational cross-sectional study of US hospitals discharging Medicare patients for congestive heart failure (CHF) or pneumonia in 2006. For each condition, we examined the association between hospital cost of care and the following variables: process quality of care, 30-day mortality rates, readmission rates, and 6-month inpatient cost of care.
  
  
  RESULTS
  Compared with hospitals in the lowest-cost quartile for CHF care, hospitals in the highest-cost quartile had higher quality-of-care scores (89.9% vs 85.5%) and lower mortality for CHF (9.8% vs 10.8%) (P < .001 for both). For pneumonia, the converse was true. Compared with low-cost hospitals, high-cost hospitals had lower quality-of-care scores (85.7% vs 86.6%, P = .002) and higher mortality for pneumonia (11.7% vs 10.9%, P < .001). Low-cost hospitals had similar or slightly higher 30-day readmission rates compared with high-cost hospitals (24.7% vs 22.0%, P < .001 for CHF and 17.9% vs 17.3%, P = .20 for pneumonia). Nevertheless, patients initially seen in low-cost hospitals incurred lower 6-month inpatient cost of care compared with patients initially seen in hospitals with the highest cost of care ($12 715 vs $18 411 for CHF and $10 143 vs $15 138 for pneumonia, P < .001 for both).
  
  
  CONCLUSIONS
  The associations are inconsistent between hospitals' cost of care and quality of care and between hospitals' cost of care and mortality rates. Most evidence did not support the "penny wise and pound foolish" hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates and greater downstream inpatient cost of care.
authors.affiliation: Division of General Medicine, Department of Internal Medicine, University of Michigan, 300 N. Ingalls, Ann Arbor, MI 48109, USA. lenac@umich.edu
authors.forename: Lena M
authors.initials: LM
authors.lastname: Chen
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
authors.forename: Stuart
authors.initials: S
authors.lastname: Guterman
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Ridgway
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Epstein
mesh_terms: D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care; D011014:Pneumonia / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D011787:Quality of Health Care / Q000191:economics*; D014481:United States