Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing

Abstract

The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

Keywords: Hospitals; Medicare; Nurses; Quality Of Care.

EXHIBIT 3. Distribution Of Standardized Balancing Scores By High And Low Staffing Hospital Groups After Matching

SOURCE Authors’ analysis of data from 2,826 hospitals. NOTE The figure demonstrates the outcome of matching in terms of achieving similarity across balancing scores for hospital groups with high and low nurse staffing. The boxplots show that the scores for the high and low staffing groups of hospitals are identical across the distribution. The line in the box is the median, the edges of the box are the twenty-fifth and seventy-fifth percentiles, and the ends of the whiskers represent the most extreme values that are within 1.5 times the interquartile range. A complete version of this exhibit showing outlier values is available in the online Appendix (see Note 20 in text).

EXHIBIT 4. Distribution Of Registered Nurse Hours Per Patient Day By High And Low Staffing Hospital Groups After Matching

SOURCE Authors’ analysis of data from 2,826 hospitals. NOTE The figure demonstrates the outcome of matching in terms of achieving differences in registered nurse staffing levels between hospital groups with high and low nurse staffing. The boxplots show that registered nurse staffing levels for both the high and low staffing groups of hospitals are different across the distribution. The line in the box is the median, the edges of the box are the twenty-fifth and seventy-fifth percentiles, and the ends of the whiskers represent the most extreme values that are within 1.5 times the interquartile range. A complete version of this exhibit showing outlier values is available in the online Appendix (see Note 20 in text).