Relationship between insurance and 30-day readmission rates in patients 65 years and older discharged from an acute care hospital with hospice services

BACKGROUND: Patients who are dual eligible for both Medicare and Medicaid have previously been shown to have increased healthcare utilization and cost. However, this relationship has not been examined for patients at the end of life. Dual eligible patients enrolled in hospice may receive more comprehensive care in the community, reducing readmissions in the final weeks or months of life. OBJECTIVE: Determine whether patients who have dual coverage with Medicare and Medicaid and are discharged with referral to hospice services after palliative care consult during their hospitalization differ in their 30-day readmission rate compared with similar patients with other types of insurance. DESIGN: Retrospective cohort study. SETTING: Three acute care hospitals affiliated with Montefiore Medical Center in the Bronx, New York. PATIENTS: In total, 2755 inpatients who received palliative care consultation and were discharged with hospice services. PREDICTOR: Dual eligible for Medicare and Medicaid compared with other insurance status. MEASUREMENTS: Readmission to Montefiore Medical Center for any reason within 30 days of the index admission. RESULTS: Overall, 9.24% of patients with dual Medicare and Medicaid coverage were readmitted within 30 days compared with 13.12% of others (adjusted odds ratio: 0.77; 95% confidence interval: 0.59-0.98; P = 0.041). CONCLUSIONS: Dual eligibility for Medicare and Medicaid is associated with lower 30-day readmission rates in patients enrolled in a hospice program. Insurance coverage that increases access to custodial care (home attendant hours and residential care) may help decrease burdensome hospital readmissions near the end of life. Journal of Hospital Medicine 2016;11:688–693.