• Amy J H Kind, Christie Bartels, Matthew W Mell, John Mullahy, and Maureen Smith.
• University of Wisconsin School of Medicine and Public Health and William S. Middleton Veterans Affairs Hospital-Geriatric Research Education and Clinical Center, Madison, Wisconsin, USA. ajk@medicine.wisc.edu
• Ann. Intern. Med. 2010 Dec 7; 153 (11): 718-27.

BackgroundAbout one quarter of rehospitalized Medicare patients are admitted to hospitals different from their original hospital. The extent to which this practice is related to for-profit hospital status and affects payments and mortality is unknown.ObjectiveTo describe and examine predictors of and payments for rehospitalization at a different hospital among Medicare patients rehospitalized within 30 days at for-profit and nonprofit or public hospitals.DesignCohort study of patients discharged and rehospitalized from January 2005 to November 2006.SettingMedicare fee-for-service hospitals throughout the United States.ParticipantsA 5% random national sample of Medicare patients with acute care rehospitalizations within 30 days of discharge (n = 74,564).Measurements30-day rehospitalizations at different hospitals and total payments or mortality over the subsequent 30 days. Multivariate logistic and quantile regression models included index hospital for-profit status, discharge counts, geographic region, rural-urban commuting area, and teaching status; patient sociodemographic characteristics, disability status, and comorbid conditions; and a measure of risk adjustment.Results16 622 patients (22%) in the sample were rehospitalized at a different hospital. Factors associated with increased risk for rehospitalization at a different hospital included index hospitalization at a for-profit, major medical school-affiliated, or low-volume hospital and having a Medicare-defined disability. Compared with patients rehospitalized at the same hospital, patients rehospitalized at different hospitals had higher adjusted 30-day total payments (median additional cost, $1308 per patient; P < 0.001) but no statistically significant differences in 30-day mortality, regardless of index hospital for-profit status.LimitationThe database lacked detailed clinical information about patients and did not include information about specific provider practice motivations or the role of patient choice in hospitalization venues.ConclusionRehospitalizations at different hospitals are common among Medicare patients, are more likely among those initially hospitalized at a for-profit hospital, and are related to increased overall payments without improved mortality.Primary Funding SourceUniversity of Wisconsin Hartford Center of Excellence in Geriatrics, National Institutes of Health.

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