The Effects of Multiple Chronic Conditions on Adult Patient Readmissions and Hospital Finances: A Management Case Study.

Medicare and other payers have launched initiatives to reduce hospital utilization, especially targeting readmissions within 30 days of discharge. Hospital managers have traditionally contended that hospitals would prosper better by ignoring the penalties for high readmission rates and keeping the beds more full. We aimed to test the financial effects of admissions and readmissions by persons with and without specified chronic conditions in one regional hospital. This is a management case study with a descriptive brief report. This study was conducted at Winchester Memorial Hospital, a general hospital in a largely rural area of Virginia, 2010-2015. The total margin per admission varied by diagnosis, with the average patient diagnosed with chronic obstructive pulmonary disease, heart failure, pneumonia, or chronic renal disease having negative margins. The largest per-patient losses were in diagnostic categories coinciding with the highest readmission rates. The margin declined into substantial losses with an increasing number of chronic conditions, which also corresponded with higher readmission rates. Patients with 5 or more clinical conditions had highest risk of readmission within 30 days (24.8%) and had an average total loss of $865 per admission in 2015. The adverse financial effects worsened between 2010 and 2015. This hospital might improve its finances by investing in strategies to reduce chronic illness hospitalizations, especially those with multiple chronic conditions and high risk of readmission. These findings counter the common claim that the hospital would do better to fill beds rather than to work on efficient utilization. Other hospitals could replicate these analyses to understand their situations.

Relations among race/ethnicity, gender, and mental health status in primary care use.

OBJECTIVE: Many working-age individuals with a serious mental health disability go without primary care. Gender and racial/ethnic disparities have been found in primary care utilization. This article examines whether the interaction of gender and race/ethnicity with serious mental health disability is associated with primary care use among working-age individuals. METHOD: We pooled data from the Medical Expenditure Panel Survey-Household Component (MEPS-HC) panels for the years 2001 to 2007 creating a sample of 34,199 individuals, 1,605 of whom had serious mental health disability. MEPS-HC is a nationally representative survey of the civilian noninstitutionalized population of the United States. We defined serious mental health disability as having scored less than 30 on the Mental Health Composite Score of the Short Form 12. Primary care visits were defined as nonspecialty, nonemergency visits to a physician's office or clinic. Zero-inflated Poisson regression models and bootstrapped predictive margins of visits were estimated using weights to account for survey design. RESULTS: Relative to women, men with serious mental health disability had significantly more primary care visits and lower log odds of "zero" visits-the opposite pattern was found for people without serious mental health disability. We did not find a significant interaction between race/ethnicity and serious mental health disability. CONCLUSION AND IMPLICATIONS FOR PRACTICE: Serious mental health disability appears to have differing impacts on men and women's use of primary care. There is a continued need to understand what differentiates users from nonusers among adults with serious mental health disability and the relative contribution of patient, provider, and system factors. (PsycINFO Database Record