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Healthcare reforms may result in increased readmissions, study suggests

Results of a new study from researchers at Boston University School of Medicine challenge perceptions of healthcare reform: that administering health insurance to people who were previously uninsured does not lower 30-day readmission rates.

“We were interested in looking at the impact of Massachusetts health care reform on 30-day readmissions, which is followed nationally and seen negatively,” Lasser said. “We thought that in Massachusetts, by extending health insurance to people that we may be able to see better care for patients once they get out of the hospital.”

The study, which was conducted by associate professor Karen Lasser, assistant professor, Amresh Hanchate and professor Nancy Kressin from BUSM’s department of medicine and published in the British Medical Journal. The researchers compared inpatient discharge databases from Massachusetts to the discharge databases of New York and New Jersey, two states that had not undergone healthcare reform, in order to determine whether or not readmission rates changed in Massachusetts.

The researchers found despite their originally hypothesis, reformed healthcare resulted in an increased risk of readmission, Lasser said.

“We controlled for variables that could affect the risk of readmission, and we found a slightly increased risk of readmissions relative to the control state,” she said. “In order to reduce readmission and reduce health disparities, we need to go beyond extending insurance coverage. There are probably things that we could do like reduce financial access barriers and the reimbursement rates for healthcare.”

A large portion of the research focused specifically on the impact of health care reform on ethnic minorities, whose rate of being uninsured decreased, Hanchate said.

“As expected the reform reduced insurance sharply from 8.4 percent in 2006 to 3.4 percent in 2009,” he said. “This reduction was even larger among racial and ethnic minorities.”

Hanchate said their study provided mixed results, with some of their research showing no change, while others presented dramatic increases.

“Our findings are mixed, with some findings pointing to improved access among minorities, but other findings indicating no change,” he said. “Specifically, we found no sizable change in the first two indicators [rate of avoidable hospitalizations and 30-day readmissions]. However, we found that use of elective procedures, such as heart procedures, knee and hip replacement procedures, improved among minorities.”

Lasser said it is difficult to draw any national conclusions from their research because so many people in Massachusetts were insured prior to the healthcare reform in 2006. She said it would be interesting to conduct a similar study in states such as Texas, where the percentage of people with healthcare coverage is significantly lower.

“It’s hard to say what this means for the rest of the country, because a lot of our patients [in Massachusetts] were insured prior to healthcare reform,” she said. “It would be interesting to look at states like Texas that have fewer people with healthcare coverage.”

Better discharge planning and patient education are a few of the additional steps that can be taken to reduce readmission, Hanchate said.

“Reducing hospital readmissions may require additional steps, including better discharge planning, educating patients on follow up with outpatient care providers, things like that.”

Hanchate said he hopes the results of this research will help to ensure equality, improved quality of healthcare and a more efficient use of health care resources.

“It is important for state and national policy, given how expensive health care is,” he said. “Answers will help guide further efforts to ensure equity in health care access, improved quality of health care and more efficient use of health care resources.”

Lasser said this is an important topic to research because with the large national effort to extend healthcare coverage, a positive impact must be insured.

“It’s important because there is so much effort that is going on nationwide to extend insurance coverage,” she said. “We really just want to make sure that it’s making a difference.”

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