Use of readmission rates to measure hospital quality 'problematic,' researchers say

Contradicting previous research, a new study finds hospitals with high readmission rates may have better mortality scores for certain conditions. The study's authors state that their findings challenge federal officials' “problematic” methods of measuring hospital quality.

Researchers at Johns Hopkins University delved into data from the Centers for Medicare & Medicaid Services showing readmission and mortality rates for nearly 4,500 hospitals over a three-year period. The research team, lead by Daniel Brotman, M.D., honed in on data for patients who had a heart attack, stroke, heart failure, chronic obstructive pulmonary disease or coronary artery bypass.

Results showed that hospitals with the highest readmission rates were more likely to keep alive those patients with heart failure, COPD or stroke. Those patients had slightly higher chances of survival at hospitals with high readmission rates than those with lower rates.

Those findings go against the Centers for Medicare & Medicaid Services' methods of linking hospitals' reimbursements and fines to readmission and mortality rates, according to researchers.

“Using readmission rates as a measure of hospital quality is inherently problematic," Brotman said. “High readmission rates could stem from the legitimate need to care for chronically ill patients in high-intensity settings.”

While some high readmission rates may be due to complications or unsuccessful care transitions, they may also be driven by frail or seriously ill patients, Brotman noted.

CMS' Hospital Compare tool, which uses star ratings to rank hospitals on 64 different quality measures, further complicates the matter by giving equal weight to readmission and mortality rates — a “particularly problematic” method that skews data against providers, Brotman said.

Full results of the study appear in the September issue of the Journal of Hospital Medicine.

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