title: A longitudinal analysis of the impact of hospital service line profitability on the likelihood of readmission.
abstract: Quality of care may be linked to the profitability of admissions in addition to level of reimbursement. Prior policy reforms reduced payments that differentially affected the average profitability of various admission types. The authors estimated a Cox competing risks model, controlling for the simultaneous risk of mortality post discharge, to determine whether the average profitability of hospital service lines to which a patient was admitted was associated with the likelihood of readmission within 30 days. The sample included 12,705,933 Medicare Fee for Service discharges from 2,438 general acute care hospitals during 1997, 2001, and 2005. There was no evidence of an association between changes in average service line profitability and changes in readmission risk, even when controlling for risk of mortality. These findings are reassuring in that the profitability of patients' admissions did not affect readmission rates, and together with other evidence may suggest that readmissions are not an unambiguous quality indicator for in-hospital care.
authors.affiliation: Department of Health Care Management, The Wharton School, The University of Pennsylvania, and Center for Health Equity Research and Promotion, Veteran's Administration Hospital, Philadelphia, PA 19146, USA. amol@wharton.upenn.edu
authors.forename: Amol S
authors.initials: AS
authors.lastname: Navathe
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Volpp
authors.forename: R Tamara
authors.initials: RT
authors.lastname: Konetzka
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Press
authors.forename: Jingsan
authors.initials: J
authors.lastname: Zhu
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Richard C
authors.initials: RC
authors.lastname: Lindrooth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004469:Economics, Hospital / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006769:Hospitals, General / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011357:Product Line Management / Q000191:economics / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D019984:Quality Indicators, Health Care / Q000191:economics / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms / Q000191:economics / Q000706:statistics & numerical data; D014481:United States