Fo­cus on read­mis­sions not hurt­ing qual­ity

Modern Healthcare - - NEWS - By Alex Kacik

Hos­pi­tals are not so fo­cused on re­duc­ing read­mis­sions that they’re ne­glect­ing mea­sures that pre­vent pa­tient mor­tal­ity, de­spite a fi­nan­cial in­cen­tive to do so, re­sults of a new study in­di­cate.

Hos­pi­tals have suc­cess­fully re­duced read­mis­sion rates for pa­tients with se­lected con­di­tions over the past sev­eral years. But some wor­ried that the up to 3% penalty Medi­care as­sesses for what it deems to be ex­ces­sive read­mis­sions would lead hos­pi­tals to re­act by do­ing things like send­ing pa­tients who should be ad­mit­ted home from the emer­gency depart­ment or be­com­ing dis­tracted from other clin­i­cal im­prove­ment ef­forts.

So far, those con­cerns are un­founded. A new study pub­lished July 18 in JAMA an­a­lyzed about 5 mil­lion Medi­care feefor-ser­vice hospi­tal­iza­tions be­tween 2008 and 2014 and found that 30-day read­mis­sion rates de­clined for all con­di­tions stud­ied—heart fail­ure, acute my­ocar­dial in­farc­tion and pneu­mo­nia. While 30-day mor­tal­ity rates slightly in­creased for heart fail­ure pa­tients over that time, they dropped for acute my­ocar­dial pa­tients and re­mained steady for those with pneu­mo­nia.

The data sug­gest that hos­pi­tals that low­ered their read­mis­sion rates also tended to have small re­duc­tions in mor­tal­ity, wrote Dr. Karen Joynt, an as­sis­tant pro­fes­sor of medicine at Wash­ing­ton Univer­sity School of Medicine, in a JAMA ed­i­to­rial. The re­sults are im­por­tant be­cause of po­ten­tial un­in­tended con­se­quences of pay­ment in­cen­tives, Joynt wrote.

The fed­eral Hos­pi­tal Value-based Pur­chas­ing pro­gram levies lower penal­ties, up to 2% of pay­ments, based on mor­tal­ity and other mea­sures, com­pared to 3% of Medi­care in­pa­tient pay­ments un­der the fed­eral Hos­pi­tal Read­mis­sions Re­duc­tion Pro­gram. “Un­der th­ese two pro­grams, the fi­nan­cial con­se­quences per ex­cess read­mis­sion far ex­ceed the fi­nan­cial con­se­quences per ex­cess death,” Joynt wrote.

Read­mis­sion rates for the three con­di­tions stud­ied by the re­searchers de­clined from 21.5% to 17.8% be­tween 2007 and 2015, the study found.

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