Increasing nurse staffing levels can help hospitals avoid penalties for excessive readmissions, according to a study.
Under the Affordable Care Act, hospitals that have excessive 30-day readmissions for Medicare patients admitted for myocardial infarction, heart failure or pneumonia are subject to financial penalties in the form of reduced payments from the Centers for Medicare and Medicaid Services. The Hospital Readmissions Reduction Program is intended to reduce preventable readmissions and is estimated to have reduced hospital payments by roughly $280 million in fiscal year 2013.
The study, published in the October issue of Health Affairs and led by Matthew D. McHugh, RN, PhD, JD, MPH, FAAN, associate professor at the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research, reveals that hospitals with higher nurse-to-patient staffing ratios have lower odds of being penalized for excessive readmissions under HRRP.
Each additional nurse hour per patient day was associated with 10% lower odds of receiving penalties
McHugh and his colleagues examined nurse staffing levels and data on readmissions penalties for 2,826 hospitals in the U.S. They found that hospitals with higher nurse staffing had 25% lower odds of being penalized than similar hospitals with lower nurse staffing ratios. Hospitals with higher nurse staffing levels also had 41% lower odds of receiving the maximum penalty for readmissions (1% of Medicare reimbursements in fiscal year 2013, 2% in FY 2014), compared with hospitals with lower staffing.
The researchers estimated that each additional nurse hour per patient day was associated with 10% lower odds of receiving penalties under HRRP. They noted that higher staffing levels reduce nurses’ workloads, which allows them to work more effectively.
“Nurses are responsible for many activities associated with reducing readmissions, including coordinating care, overseeing care in the hospital, planning for patients’ discharge from the hospitals and educating patients and their families about what to do when they return home,” McHugh said in a news release.
“It’s rather intuitive that when they have adequate staffing and resources to carry out these activities properly, readmission rates decline. This study strongly supports the idea that nurse staffing is one key component of healthcare delivery that hospitals can address to both improve patient outcomes and reduce the likelihood of being penalized for excessive readmissions.”
McHugh is a Robert Wood Johnson Foundation Nurse Faculty Scholar, and was one of 12 nurse educators across the country selected in 2011 to participate in the program and to receive a three-year $350,000 grant to conduct research.
The goal of the RWJF Nurse Faculty Scholars program is to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty. The program aims to strengthen the academic productivity and overall excellence of nursing schools by providing mentorship, leadership training and salary and research support to young faculty. It is funded by RWJF and administered through the Johns Hopkins University School of Nursing.