Good news hard to find in 30-day readmissions data
Newly updated 30-day readmissions data posted to the CMS’ consumer website shines a spotlight on a few higher- and lower-performing hospitals while revealing little progress nationally.
The Hospital Compare update comes not long before the CMS is scheduled to begin an aggressive program to curb preventable rehospitalizations. On Oct. 1, the agency will launch its readmissions reductions program, an initiative that will penalize inpatient hospitals whose readmissions rates put them in the bottom-performing quartile of hospitals in the nation.
Florida Hospital, a 2,083-bed facility in Orlando, was among eight hospitals designated as having “worse than expected” rates of hospital readmissions for all three conditions— heart failure, heart attack and pneumonia— reported on Hospital Compare. That’s despite several years of trying to improve discharge-planning processes and continuity of care, said Rich Morrison, the hospital’s senior vice president of government and public affairs.
Based on data from its own internal tracking system, Florida Hospital expected to be among the low performers for heart attack and heart failure readmissions, but being included for pneumonia as well came as a surprise, Morrison said.
Morrison argued that too much of the burden—and the financial penalties— associated with readmissions are being placed on hospitals. “We ought to be held accountable for what we can control, but it is not reasonable, in our opinion, to be held
responsible for what we can’t,” he said. “I have no control over what happens in nursing homes or in home care. We need to have the incentives aligned so there is accountability on those segments of the healthcare continuum.”
The coming penalties, calculated using hospitals’ “excess readmission rates,” will top out at 1% of base operating DRG payments in fiscal 2013, 2% in 2014 and 3% in 2015.
Although the timeframe used for the readmissions reduction program—July 1, 2008, though June 30, 2011—is the same as the period covered in the Hospital Compare update, CMS officials cautioned that one could not be used to predict the other.
“The calculations that will be used for the hospital readmissions reduction program will be different,” the CMS said in e-mailed comments. The CMS confidentially told hospitals the rates under the readmissions program about a month ago, the agency said.
Florida Hospital fully expects to be included in that bottom-performing quartile and has adjusted the anticipated penalty into its yearly budget accordingly, Morrison said. “We have made progress, but I don’t think you’ll see our numbers move on Hospital Compare for another year and half or so because these problems are so complex,” he said.
Also among the eight hospitals recognized on Hospital Compare as performing worse than expected on readmissions across all three conditions were Beth Israel Deaconess Medical Center, Boston; Henry Ford Hospital, Detroit; and Olympia Medical Center, Los Angeles. Beth Israel Deaconess and Olympia, however, scored “better than expected” on mortality for all three conditions, and Henry Ford did so for two conditions.
“There seems to be a national phenomenon whereby many hospitals that perform well on mortality rates at the same time are challenged to do well on readmissions,” said Dr. Kenneth Sands, Beth Israel Deaconess’ senior vice president of healthcare quality. “It’s not entirely clear what the relationship is and what drives it.”
Sands added: “If we were to choose which one to be stellar on, though, it would be mortality.”