Table 2. Relationship Between Hospital Financial Performance and 30-Day Mortality and Readmission Rates*.
| No. | Median % (IQR) | Adjusted % Change (95% CI) per $50 Million Increase in Net Revenue From Operations† | ||
|---|---|---|---|---|
|
| ||||
| Overall | Extreme Outliers Excluded‡ | |||
| Myocardial infarction | ||||
| Mortality rate | 211 | 15.2 (14.2–16.2) | 0.07 (−0.10 to 0.24) | 0.63 (−0.21 to 1.48) |
| Readmission rate | 184 | 19.4 (18.5–20.2) | Nonlinear§ | −0.34 (−1.17 to 0.50) |
| Congestive heart failure | ||||
| Mortality rate | 259 | 11.1 (10.1–12.1) | 0.17 (−0.01 to 0.35) | Nonlinear‖ |
| Readmission rate | 264 | 24.5 (23.5–25.6) | −0.07 (−0.27 to 0.14) | −0.45 (−1.36 to 0.47) |
| Pneumonia | ||||
| Mortality rate | 268 | 11.6 (10.4–13.2) | −0.17 (−0.42 to 0.07) | −0.35 (−1.19 to 0.49) |
| Readmission rate | 268 | 18.2 (17.3–19.1) | −0.04 (−0.20 to 0.11) | −0.56 (−1.27 to 0.16) |
NOTE: Abbreviations: CI, confidence interval; IQR, interquartile range.
Thirty-day outcomes are risk standardized for age, sex, comorbidity count, and indicators of patient frailty.3
Each outcome was modeled separately and adjusted for teaching status, metropolitan status (urban vs rural), bed size, safety-net hospital status, hospital ownership type, Medicare caseload, and volume of cases reported for the respective outcome, accounting for clustering of hospitals by owner.
Twenty-three hospitals were identified as extreme outliers with respect to net revenue from operations (10 “underperformers” with net revenue <−$49.4 million and 13 “overperformers” with net revenue >$52.1 million). §There was a nonlinear and statistically significant relationship between net revenue from operations and readmission rate for myocardial infarction. Net revenue from operations was modeled as a cubic spline function. See Figure 1. The overall adjusted F statistic was 4.8 (P < 0.001).
There was a nonlinear and statistically significant relationship between net revenue from operations and mortality rate for heart failure after exclusion of extreme outliers. Net revenue from operations was modeled as a cubic spline function. See Figure 1.The overall adjusted F statistic was 3.6 (P = 0.008).