title: Surgical rehospitalization of the medicare fee-for-service patient: a state-level analysis exploring 30-day readmission factors.
abstract: OBJECTIVE
  Surgical readmissions are a concern to the integrity of the Medicare Trust Fund and gaining attention from policymakers concerned about solvency. This study explores factors associated with variation in surgical readmission rates across the states and provides implications for Medicare Case Management.
  
  
  METHODS
  Acute inpatient hospital settings.
  
  
  METHODS
  Fifty state-level data and multivariate regression analysis are used. The dependent variable Surgical Discharge 30-day Readmission Rate is based on the Medicare Fee-For-Service beneficiary population with Medicare Part A and B insurance coverage and age 65 years or older, rehospitalized subsequent to an inpatient surgical procedure, occurring within 30 days of their last discharge.
  
  
  RESULTS
  Our 2 key explanatory variables-emergency room visit rate and total days of care-are each positively associated with 30-day surgical readmission rate. Age group 65-69 years, native language, physician density, and health care expenditures per capita also influence surgical readmission rate across the states.
  
  
  CONCLUSIONS
  Surgical readmission has an association with many different categories of variables-demographic, clinical process, hospital capacity, and patient need. This strongly suggests that Medicare case managers consider the wide range of elements contributing to surgical readmission and take a multifactorial approach to reducing the rehospitalization rate.
authors.affiliation: Mary Schmeida, PhD, is an expert in public health policy who has served in several key research positions. Her research in health care and welfare policy has been published and presented nationally and internationally. She can be contacted at HYPERLINK "mailto:mschmeid@kent.edu"mschmeid@kent.edu. Ronald Savrin, MD, MBA, is an internationally recognized vascular surgeon who has served as the professor of surgery and has held numerous administrative, educational, and corporate appointments. He has led state and national quality improvement programs and is actively engaged in nationwide efforts to improve the medical care delivery system.
authors.forename: Mary
authors.initials: M
authors.lastname: Schmeida
authors.forename: Ronald
authors.initials: R
authors.lastname: Savrin
mesh_terms: D000368:Aged; D019090:Case Management / Q000191:economics / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D006278:Medicare / Q000458:organization & administration; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012307:Risk Factors; D014481:United States