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Research links short hospital stays to higher readmission rates

Eastern professors examine healthcare quandary

by Noel Teter

Willimantic, CT (01/13/2026) — Faculty research at Eastern Connecticut State University suggests that keeping patients hospitalized longer - rather than discharging them quickly - may reduce costly and harmful readmissions, challenging prevailing insurance-driven incentives in U.S. healthcare.

Since 2016, College of Business Professors Fatma Pakdil and Steve Muchiri have co-investigated hospital length of stay (LOS) and readmission rates among patients with serious conditions, including congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD).

The pair has published several papers concerning Medicare and Medicaid patients in the "International Journal of Healthcare Management." In a 2024 paper examining LOS and readmission rates in COPD patients, "longer LOS was associated with reduced readmission rates," said Pakdil. In other words, patients who are able to stay at the hospital longer during their initial stay are less likely to return for the same issue.

Pakdil continued: "In this particular paper, we also found that insurance type, socioeconomic factors (including social determinants of health), and hospital characteristics are additional factors affecting readmission rates and LOS among COPD patients."

A common social determinant of health is income level, which influences the quality of insurance patients have and the care they receive as a result. Muchiri explained that lower-income patients, who are disproportionately un- or underinsured, are more susceptible to adverse health effects: "If you don't have good health to begin with or you're from a poor home, you're more likely to have more conditions the older you get."

In addition, quality of care metrics, such as optimal expected LOS, can lead to patients being discharged too early, only to be readmitted later. Using a five-day optimal LOS as an example, Muchiri explained, "If you stay more than five days, the insurance is not going to pay for it. If the patient stays less than five days, the hospital gets a profit because it gets paid for five days even though the patient stayed for three," for example.

He continued: "(Hospitals) are more likely to push for a shorter length of stay because if (patients) stay longer, the hospital doesn't get paid." However, "if a patient is readmitted, (the patient is) more likely to be penalized (by insurance) for that. If they stay less, they're more likely to be readmitted."

In other words, readmission results in patients being penalized by their insurance. While hospitals push for lower initial LOS so they may make a profit, patients who do not stay long enough initially are more likely to be readmitted and pay a high price.

Pakdil added: "Once you discharge the patient, you never know when they are going to come back to your hospital. This is a billion-dollar problem for the United States healthcare system." According to research cited by Pakdil and Muchiri in their 2024 paper, unplanned hospital readmissions presented a $17.4 billion cost to Medicare in 2004.

With patients and hospitals caught between a rock and a hard place, Pakdil and Muchiri hope their research will help policymakers "incentivize better quality of care," said Muchiri.

Pakdil sees a potential solution in the Hospital Readmissions Reduction Program (HRRP), managed by the Centers for Medicare & Medicaid Services (CMS). "Our findings should be able to help policymakers identify expected LOS for some specific conditions that are monitored by the HRRP," she said.

Pakdil continued: "Policymakers need to look at the relationship between LOS and readmission. CMS determines the expected LOS for many different conditions. ... From an optimization perspective, what happens to readmission probability if you increase LOS one day or if you decrease LOS one day?"

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Eastern Connecticut State University is the state of Connecticut's public liberal arts university, serving upwards of 4,000 students annually on its Willimantic campus. A residential campus offering 41 majors and 68 minors, Eastern offers students a strong liberal arts foundation grounded in a variety of applied learning opportunities. Ranked among the top 25 public institutions in the North by U.S. News & World Report in its 2025-26 Best Colleges ratings, Eastern has also been awarded 'Green Campus' status by the Princeton Review 15 years in a row. For more information, visit www.easternct.edu.

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Fatma Pakdil and Steve Muchiri

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