Higher Nurse Staffing Levels Associated With Lower Odds of Readmission Penalties

    • October 8, 2013

Philadelphia, P.A.—Under the Affordable Care Act (ACA), hospitals that have excessive 30-day readmissions for Medicare patients admitted for heart attacks, heart failure or pneumonia are subject to financial penalties in the form of reduced payments from the Centers for Medicare and Medicaid Services (CMS). The Hospital Readmissions Reduction Program (HRRP) is intended to reduce preventable readmissions and is estimated to reduce hospital payments by roughly $280 million in fiscal year 2013. According to a new study published in the October issue of Health Affairs, increasing nurse staffing levels may help hospitals avoid these penalties.

The study, led by Matthew D. McHugh, PhD, JD, MPH, RN, FAAN, associate professor at the University of Pennsylvania School of Nursing, 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.

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 percent lower odds of being penalized than similar hospitals with lower nurse staffing ratios. Hospitals with higher nurse staffing levels also have 41 percent lower odds of receiving the maximum penalty for readmissions, compared with hospitals with lower staffing. The researchers estimate that each additional nurse hour per patient day is associated with 10 percent lower odds of receiving penalties under HRRP.

The research team 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,” said McHugh. “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 health care delivery that hospitals can address to both improve patient outcomes and reduce the likelihood of being penalized for excessive readmissions.”

The research team also included Julie Berez, an undergraduate student and research assistant at the Center for Health Outcomes and Policy Research at the University of Pennsylvania, and Dylan Small, PhD, associate professor of statistics, Wharton School, University of Pennsylvania.

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