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Staffing Up To Avoid Hospital Readmissions Penalties?

Hospitals with Larger Nursing Staffs Had 25% Lower Odds of Being Penalized

The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries with acute myocardial infarction, heart failure, or pneumonia. In FY2013, the penalties reduced payments to hospitals by an estimated $280 million. The goal is to give hospitals a financial incentive to improve care and to curb the estimated $15 billion Medicare spends annually on these readmissions.

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Matthew McHugh, PhD, JD, MPH, RN, CRNP, is an Associate Professor of Nursing at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and a Senior Fellow at Penn's Leonard Davis Institute of Health Economics.

Research shows that hospitals can reduce readmissions by implementing evidence-based standards of care such as discharge preparation, care coordination, and patient education -- standards largely carried out by nursing staff.

Medicare penalties
Other evidence suggests that hospitals with higher levels of nurse staffing have lower readmissions rates. That leads to the question, how did nurse staffing levels affect the likelihood of incurring Medicare penalties this year?

University of Pennsylvania School of Nursing's Matthew McHugh provides some answers in a new study published in Health Affairs. He analyzed HRRP data on 2,826 hospitals: 28% received no penalty, 9% received the maximum penalty, and 63% had some, though not the maximum, penalty. He used a matching approach to compare well-staffed hospitals with otherwise similar hospitals with lower staffing levels. The average staffing level, in the high staffing group was 8.0 registered nurse hours per adjusted patient day, versus 5.1 in the low staffing group.

25% lower odds
Dr. McHugh found that hospitals with larger nursing staffs had 25% lower odds of being penalized compared to similar hospitals with smaller staffing. When comparing maximum penalty hospitals to all others, he found an even bigger effect: hospitals with higher nurse staffing had 41% lower odds of receiving the maximum penalty compared to their lower-staffed counterparts.

These results point to nurse-staffing levels as potential system-level interventions through which hospitals can meet their quality goals and reduce readmissions penalties. In this new regulatory environment, hospital administrators may have a new bottom line to consider in their nurse-staffing decisions.