Focus on readmissions not hurting quality
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.