Are We Using the Right Formula to Evaluate Hospitals’ Performance?

Posted by The Evidence Blog on March 3, 2015

Even though preventable hospital readmissions for Medicare patients are declining overall, a record number of hospitals will be penalized over the next year for excessive readmissions. According to an analysis of federal records by Kaiser Health News, the Centers for Medicare & Medicaid Services (CMS) will penalize more than 2600 hospitals that have the highest readmission rates—433 more hospitals than the previous year.

There’s no debate that readmissions drive up costs. The Agency for Healthcare Research and Quality (AHRQ) analyzed data from the Healthcare Cost and Utilization Project (HCUP) and found that in 2011, readmissions contributed $41.3 billion in total hospital costs.

CMS calculates a hospital’s readmission rate by dividing the number of readmissions by overall discharges. Some critics have slammed this approach, asserting that when hospitals incorporate practices that also reduce discharges at commensurate rates as admissions, it may appear that little progress is being made.

The results of 2 studies published in the February 3rd issue of the Journal of the American Medical Association (JAMA) raise questions about the value of using readmission rates as a key metric to evaluate hospitals’ performance. In an analysis of almost 500,000 surgeries, readmissions after surgery were found to be primarily because of new surgical complications rather than a worsening of patients’ prior medical issues. The most common reason for readmission was surgical site infections, which occurred in 19.5% of postoperative readmissions.

Can hospitals improve surgical outcomes? Probably. But as a second study shows, among hospitals that participated in a national quality improvement program and received feedback, surgical outcomes were no better than they were among nonparticipating hospitals.

A third study suggests that hospitals actually may have little control over hospital readmission rates. This randomized trial followed 500 patients with congestive heart failure or chronic obstructive pulmonary disease. Half received a comprehensive intervention that included predischarge education, follow-up after discharge, and other activities to monitor patients’ symptoms after leaving the hospital; 30-day and 90-day readmissions were not statistically different between the intervention and control groups.

We predict that hospital readmissions will be a topic of much discussion over the coming months. In the wake of the record number of readmission penalties, hospitals will be looking for the best ways to gain more control over the process of reducing readmissions. From our perspective, integrating evidence into clinical practice and consistently using evidence-based clinical practice guidelines will help to reduce and eliminate clinical variation and ultimately drive quality outcomes.

Topics: Hayes Blog

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