Variation Among Primary Care Physicians in 30-Day Readmissions

Area of Science:

• Health Services Research
• Quality Improvement in Healthcare
• Physician Performance Measurement

Background:

• Federal policy increasingly holds primary care physicians (PCPs) accountable for patient readmission rates.
• However, it remains unknown whether significant variations in readmission rates exist among PCPs.

Purpose of the Study:

• To determine if 30-day patient readmission rates differ significantly across individual PCPs.

Main Methods:

• A retrospective cohort study analyzed 100% of Texas Medicare claims from 2008 to 2015.
• Marginal models and multilevel logistic regression were used to assess readmission rates.
• Data included patients discharged alive with a PCP in the prior year and PCPs with at least 50 admissions.

Main Results:

• The mean risk-standardized 30-day readmission rate was 12.9% between 2012 and 2015.
• Among 4230 PCPs, only one had a significantly higher readmission rate; none had a significantly lower rate.
• The difference between the 10th and 90th percentiles of PCP readmission rates was only 0.5 percentage points.

Conclusions:

• There is very low variation in 30-day readmission rates among PCPs.
• Accountability programs for PCPs focused on readmissions may be ineffective.
• Further research is needed to understand factors influencing readmissions and to develop effective quality improvement strategies.