Abstract 17858: Does Market Competitiveness Impact Readmission Rates for Elderly Patients With Heart Failure?
Heart failure (HF) is the most common cause of both hospitalizations and readmissions in the Medicare program. Recently, the federal government has begun public reporting of processes and outcomes of care for HF, including HF-specific Hospital Quality Alliance (HQA) scores and 30-day readmission rates. Advocates of market-based health care reform strategies argue that competition between hospitals on these publicly-reported measures will drive improvements in quality. We analyzed national Medicare data from 2006-2007 on all hospitalizations with a primary discharge diagnosis of HF. We created risk-adjusted readmission rates for each of the 4734 hospitals in our sample, and calculated each hospital's Herfindahl-Hirschman Index (HHI), a measure of the level of competitiveness in each health care market (as designated by health care referral regions, or HRRs). We categorized markets into four groups: highly competitive (HHI<0.05), competitive markets (HHI 0.05-0.10), concentrated markets (HHI 0.10-0.18), and highly concentrated markets (HHI>0.18). Hospitals in highly competitive markets were slightly larger, on average, and were more likely to be teaching hospitals. There were no differences in cardiac catheterization facilities, cardiac intensive care facilities, or proportion of Medicaid patients across levels of competitiveness. Contrary to our hypothesis, hospitals in highly competitive markets had, on average, lower performance on process measures of quality of care and higher 30-day readmission rates for HF. These findings persisted even after adjusting for hospital size, ownership, and system membership (Table). In conclusion, we found no evidence that highly competitive markets provide better care, for HF, as measured by HQA HF score or by 30-day readmission rates. Ensuring adequate competition in a healthcare marketplace may not be an effective strategy for improving the quality of care Americans receive.
- © 2010 by American Heart Association, Inc.