Should Hospitals Keep Their Patients Longer? The Role of Inpatient Care in Reducing Post-Discharge Mortality

36 Pages Posted: 22 Sep 2014 Last revised: 4 Jan 2021

See all articles by Ann P. Bartel

Ann P. Bartel

Columbia Business School - Finance and Economics; National Bureau of Economic Research (NBER)

Carri Chan

Columbia University - Columbia Business School

Song-Hee Kim

Seoul National University - Business School

Date Written: September 2014

Abstract

The Centers for Medicare & Medicaid Services (CMS) and the National Quality Forum have endorsed 30-day mortality rates as important indicators of hospital quality. Concerns have been raised, however, as to whether post-discharge mortality rates are reasonable measures of hospital quality as they consider the frequency of an event that occurs after a patient is discharged and no longer under the watch and care of the hospital. Using a large dataset comprised of all hospital encounters of every Medicare patient from 2000 to 2011 and an instrumental variables methodology to address the potential endogeneity bias in hospital length-of-stay, we find evidence that 30-day mortality rates are appropriate measures of hospital quality. For patients with diagnoses of Pneumonia or Acute Myocardial Infarction, an additional day in the hospital could decrease 30-day mortality rates by up to 12.8%. Moreover, we find that, from a social planner's perspective, the gains achieved in reducing mortality rates far exceed the cost of keeping these patients in the hospital for an additional day.

Suggested Citation

Bartel, Ann P. and Chan, Carri and Kim, Song-Hee, Should Hospitals Keep Their Patients Longer? The Role of Inpatient Care in Reducing Post-Discharge Mortality (September 2014). NBER Working Paper No. w20499, Available at SSRN: https://ssrn.com/abstract=2499341

Ann P. Bartel (Contact Author)

Columbia Business School - Finance and Economics ( email )

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National Bureau of Economic Research (NBER)

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Cambridge, MA 02138
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Carri Chan

Columbia University - Columbia Business School ( email )

3022 Broadway
New York, NY 10027
United States

Song-Hee Kim

Seoul National University - Business School ( email )

Seoul
Korea, Republic of (South Korea)

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