Same-hospital readmission rates are an unreliable predictor for all-hospital readmissions rates, but that rate is what CMS penalizes hospitals for, according to research from the University of Michigan (U-M) Health System, presented at the 2013 Clinical Congress of the American College of Surgeons.
By tracking readmission rates solely within their own facility, instead of looking at rates at other hospitals, officials aren’t getting enough information to effectively target areas for quality improvement, researchers say.
Approximately one in five Medicare patients are rehospitalized within 30 days of discharge, a rate CMS considers excessive, and began penalizing hospitals for in October 2012. Hospitals have since strategized how to decrease their rates without compromising patient care and quality.
But unless hospitals are top or bottom performers for readmissions, same-hospital readmission rates may be very misleading. For the study, researchers evaluated three years of data on 660,700 Medicare patients undergoing one of three major surgical operations: coronary artery bypass grafts, hip fracture repair, and colectomy. Within this group, 13 percent had at least one readmission within 30 days of their operation and two-thirds were readmitted to the same hospital.
Researchers generated risk-adjusted rates of same-hospital and all-hospital readmissions. They then ranked hospitals from lowest to highest readmission rates and divided them into five groups, or quintiles, based upon their ranking. They then compared how hospital performance based upon same-hospital readmission rate compared with performance under all-hospital readmissions, and found that 42 percent of hospitals were reclassified into a different quintile of performance.
Of the hospitals performing in the top quintile based on same-hospital readmission, nearly 24 percent were reclassified when rankings were based on all-hospital readmission. This pattern was most exaggerated in the median quintile, where 55 percent were reclassified under all-hospital readmissions rankings.
In order to decrease readmissions and improve quality of care, hospitals need to have access to real-time data, the report notes. This access could come in a number of forms, including a surgical quality improvement collaborative where information is quickly and easily exchanged among participants. While CMS currently sends institutions annual hospital-specific reports, the information is already a year old. Incorporating real-time data could significantly improve the efficiency of the quality improvement cycle, researchers conclude.
Source: University of Michigan Health System, October 3, 2013
2012 Healthcare Benchmarks: Reducing Hospital Readmissions identifies the key strategies, challenges, target populations and health conditions of 119 healthcare organizations to reduce avoidable rehospitalizations, and provides critical benchmarks that show how the industry is working to reduce rehospitalizations, particularly for the CMS target conditions of heart failure, myocardial infarction and pneumonia.