Abstract 11367: Association between Outpatient Visits Following Hospital Discharge and Readmissions among Medicare Beneficiaries with Atrial Fibrillation

Abstract

Introduction Beginning in 2013, the Centers for Medicare & Medicaid Services (CMS) will penalize hospitals for certain excessive 30-day readmission rates. While studies examine the relationship between outpatient follow-up and readmission rates for persons with coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), heart failure (HF), and diabetes, beneficiaries with atrial fibrillation (AF), of which there were an estimated 2.66 million in 2010, are widely overlooked. This study examines the relationship between outpatient visits within 14 days after hospital discharge and readmission within 30, 60, and 90 days.

Methods We analyzed Medicare fee-for-service claims and enrollment data (2006-2009) for beneficiaries with AF and those with other non-AF chronic conditions (CAD, COPD, HF, and diabetes). The association between an outpatient visit within 14 days of hospital discharge and 30-, 60-, and 90-day all-cause readmission was evaluated using logistic regression. Readmission rates were calculated at the beneficiary level rather than at the discharge level.

Results The study population included 283,580 AF beneficiaries and 375,655 beneficiaries without AF but with other chronic conditions.The 30-, 60-, and 90-day patient-level readmission rate for AF beneficiaries was 10.9%, 16.8%, and 21.1% compared to slightly lower rates of 9.3%, 14.1%, and 17.9% for those with non-AF chronic conditions. Among those with a hospitalization, 51.4% of AF beneficiaries and 47.0% of other beneficiaries had an outpatient visit within 14 days of discharge. The rate of readmission was 11% to 24% lower for AF and non-AF beneficiaries with an outpatient visit compared to those without a visit (30 days: 9.5% vs. 12.4% for AF and 8.0% vs. 10.5% for non-AF; 60 days: 15.4% vs. 18.3% for AF and 12.9% vs. 15.3% for non-AF; and 90 days: 19.8% vs. 22.4% for AF and 16.7% vs. 18.9% for non-AF).

Conclusions Medicare beneficiaries with AF had slightly higher readmission rates than their peers with other common chronic conditions. Having an outpatient visit within 14 days of discharge was associated with a lower likelihood of 30-day readmission and may suggest that improved care coordination might lower hospitals’ risks of being penalized for readmissions.