Is Profit Status of Inpatient Rehabilitation Facilities Independently Associated With 30-Day Unplanned Hospital Readmission for Medicare Beneficiaries?

Abstract

Objective: To investigate the effects of facility-level factors on 30-day unplanned risk-adjusted hospital readmission after discharge from inpatient rehabilitation facilities (IRFs).

Design: Study using 100% Medicare claims data, covering 269,306 discharges from 1094 IRFs between October 2010 and September 2011.

Setting: IRFs with at least 30 discharges.

Participants: A total number of 1094 IRFs (N=269,306) serving Medicare fee-for-service beneficiaries.

Interventions: Not applicable.

Main outcome measures: Risk-standardized readmission rate (RSRR) for 30-day hospital readmission.

Results: Profit status was the only provider-level IRF characteristic significantly associated with unplanned readmissions. For-profit IRFs had a significantly higher RSRR (13.26±0.51) than did nonprofit IRFs (13.15±0.47) (P<.001). After controlling for all other facility characteristics (except for accreditation status because of its collinearity with facility type), for-profit IRFs had a 0.1% point higher RSRR than did nonprofit IRFs, and census region was the only significant region-level characteristic, with the South showing the highest RSRR of all regions (type III test, P=.005 for both).

Conclusions: Our findings support the inclusion of profit status on the IRF Compare website (a platform including IRF comparators to indicate quality of services). For-profit IRFs had a higher RSRR than did nonprofit IRFs for Medicare beneficiaries. The South had a higher RSRR than did other regions. The RSRR difference between for-profit and nonprofit IRFs could be due to the combined effects of organizational and regional factors.

Keywords: Long-term care; Nonprofit; Organizations; Patient readmission; Rehabilitation.