Working Paper: NBER ID: w20499
Authors: Ann P. Bartel; Carri W. Chan; Songhee Hailey Kim
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.
Keywords: healthcare; medicare; econometric analysis; length of stay; mortality; hospital quality
JEL Codes: I10; I13; I18; L38
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| hospital length of stay (LOS) (I11) | postdischarge mortality rates (J17) |
| hospital length of stay (LOS) (I11) | 30-day mortality risk (AMI) (G32) |
| hospital length of stay (LOS) (I11) | 30-day mortality risk (PNE) (F34) |