Study questions readmission data as standard for care quality

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A new study widened the readmission lens to include non-cardiac patients and other payers
A new study widened the readmission lens to include non-cardiac patients and other payers

Hospital readmission rates have emerged as the unquestioned arbiter of post-acute care quality and payments. But a new study suggests a more comprehensive approach may be warranted.

Cardiologists at the Beth Israel Deaconess Medical Center focused on readmission rates after hospitalizations for heart failure, acute myocardial infarction and pneumonia, as the Centers for Medicare & Medicaid Services keys on such data to assess quality and determine reimbursement rates. The investigators concluded that readmission rates as currently used do not accurately reflect quality of care provided to patients with other health conditions or those with health care coverage other than Medicare.

The study found significant differences in hospitals' performance when overall readmissions assessments included non-Medicare patients and a broader range of conditions. According to the study, half of all hospitals would see a change in their financial penalty status if additional factors were considered.

Hospitals have been more selective in choosing post-acute providers in recent years, in part because of the pressure to reduce readmissions within a 30-day window. Financial penalties went into place five years ago, and critics have become increasingly concerned about the validity of readmission data.

In the new study, within-hospital differences in readmissions varied widely among groups. Among hospitals with higher readmission ratios, readmits for the Medicare reported group tended to overestimate excess readmission rates for the non-Medicare group and underestimate readmission for the Medicare unreported group.

“Hospital ERRs, as estimated by Medicare to determine financial penalties, have poor agreement with corresponding measures for populations and conditions not tied to financial penalties,” the researchers reported. “Current publicly reported measures may not be good surrogates for overall hospital quality related to 30-day readmissions.”