Disparities in postdischarge follow-up and risk of readmission between Medicaid and privately insured patients

Abstract

Background

Studies have identified higher risk of readmission for patients with Medicaid compared to those with private insurance. Postdischarge follow-up is utilized as an intervention to reduce readmissions in the Medicare population, but it is unclear whether follow-up reduces risk of readmission for patients with Medicaid.

Objective

To assess whether follow-up within 30 days of discharge reduces risk of readmission and mitigates readmission disparities based upon insurance status.

Methods

This retrospective cohort study used Cox proportional hazard and competing risk models to estimate associations between sociodemographic and clinical characteristics, follow-up, and readmission.

We analyzed data from 4281 patients aged 21–64 years with Medicaid or private insurance who were hospitalized from January 2017 to December 2019 for one of five conditions associated with high risk of readmission.

Outpatient follow-up within 30 days of discharge and 30-day all-cause readmission were outcomes.

Results

Overall risk of readmission was similar for Medicaid and privately insured patients in this cohort (13.7% and 14.5%, respectively). Patients with Medicaid were 23% points less likely to complete outpatient follow-up within 30 days compared to patients with private insurance (p < .001). However, outpatient follow-up before readmission within 30 days of discharge was not associated with a significant difference in readmission rate (hazard ratio: 1.10, 95% confidence interval: 0.91–1.32) in the overall sample or in analysis stratified by payer.

Conclusions

We found similar rates of readmission for Medicaid and privately insured patients despite significant disparities in postdischarge follow-up. Timely follow-up care alone may not be sufficient as an intervention to reduce readmissions.