Length of Stay and Reimbursement Rates for Medicare Patients

Wandella Ezell, Walden University


Medicare reimbursement rates across the United States have varied by as much as 49-130% across healthcare facilities. Geographic adjustments and severity of medical diagnoses attribute to some dissimilarity; however, the source of longer hospitalization and higher re-admission rates among Medicare patients requires financial consistency. The research encompassed (N = 3000) patients with hypertension as the focus for the study because this is a critical group of Medicare patients with a chronic disease that has been identified as a silent killer. The principal goal that drove this research study was to explain the variations in length of stay for Medicare patients with hypertension. The theoretical framework was the epidemiological triad model composed of person, place, and time variables. A secondary data set was acquired from the Healthcare Cost and Utilization Project Nationwide database of the National Inpatient Sample for the duration of 2011 - 2013. A multiple logistic regression analysis was conducted to determine if there was a correlation between length of stay and reimbursement rates for hypertensive Medicare patients. The findings of this research study provided an analytical explanation for the forces that have been driving Medicare patients' LOS, and rate of reimbursement. The research study yielded variations in the rate of reimbursement for a government entity in medical charges by illustrating the utilization of geographic price variations. The findings revealed that the categorical variable LOS and reimbursement rates for Medicare hypertensive patients had a significant correlation, and with higher reimbursement rates that were associated with longer hospital duration. The findings of the research study may inform Medicare decision-makers to eliminate geographic price variation and provide greater consistency in the rate of reimbursement, as well as a uniformity in length of stay across all regions of the United States.