It’s purely coincidental that it’s Easter week and I’m writing about putting all of your eggs in one basket. The researchers put me up to it.
Not directly, of course. But after reading their findings, I feel compelled to not let this one simmer any longer.
If there has been one subject that hospital officials, vendors and regulators all have obsessively clammered about, it is rehospitalization rates. Help us keep them low and we’ll be your best business friend, hospitals none-too-subtly have told their caregiving partners up and down the continuum.
You can’t really blame them. Federal regulators have held their feet to the fire, and it hasn’t been comfortable.
Skilled nursing and rehab providers, of course, have known this is a hard-to-win proposition. Discharged hospital patients are not cans of beans speeding down a conveyor belt, perfectly lending themselves to equal comparisons.
Readmissions are tough to qualify, yet alone quantify. Perhaps they shouldn’t be leaned on so much — at least not in the current manner — the scientific community has come to realize. The only question is: Will Uncle Sam take the cotton out of his ears and listen?
Earlier this week, we wrote about cardiologists studying rehospitalization rates with relation to heart failure, heart attacks and pneumonia. These are the conditions the federal government relies on to determine quality and, therefore, payment and penalty rates.
It turns a little more sophistication might be needed when trying to calculate readmission rates. (Who knew healthcare could be so complicated?)
A broader range of conditions, of course, would be helpful when considering actual readmission rates. It turns out that that presence of non-Medicare patients also significantly impacts performance measurements.
Comparing apples and oranges is tough enough, but then try comparing the prices of the different fruits between the corner market and Sam’s Club … well, forget it.
Hospitals started getting dinged on 30-day rehospitalization rates five years ago. Long-term care will be next under the microscope. That’s why you should be concerned. How will people evaluate individuals who have passed through your care? Your livelihood may depend on it.
Other studies have questioned whether hospital patients have actually been getting better under pressure to lower rehospitalization rates. Some skeptics have alleged shortcuts are being taken, leading to compromised care and masked outcomes.
In one case, University of Michigan researchers found that hospitals were simply describing their patients as sicker than they were in order to fare better on subsequent analysis and pay scales.
Another study, by Harvard and UCLA researchers, found a correlation between reduced readmissions and an increase in death rates — both short-term (30 days) and longer term (one year). That ought to be enough to compel a big pause.
Certainly, everyone wants sustained, well-thought out quality efforts. There must be caution, however, that the campaigns don’t turn into a blindly obedient procession. We have enough of that approach as it is in popular political discourse.
Besides, there’s maybe only one week a year that it’s a good idea to put all of your eggs in one basket, and it’s going to end very soon.
Follow McKnight’s Editor James M. Berklan @JimBerklan.