Readmission calculations unfair to hospitals

25% of spine surgery readmissions not caused by quality-of-care issues
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Readmission rates can hurt hospitals' reputations and, starting this month, reimbursements. But new research suggests the readmission calculation is flawed, as 25 percent of the readmissions of spine surgery patients were not due to true quality-of-care issues.

According to researchers at Loyola University Medical Center and University of California San Francisco Medical Center, the standard method used to calculate readmission rates is a misleading indicator of hospital quality, according to the research presented at yesterday's Congress of Neurological Surgeons in Chicago.

Under the 2010 Affordable Care Act that triggered the Readmissions Reduction Program, hospitals with excess readmissions see Medicare penalties of up to 1 percent. However, current calculations may not account for other factors that affect readmission rates, according to researchers.

Although some readmissions are genuinely related to poor quality, such as infections, surgical complications, blood clots and surgical hardware failures, a quarter of cases are not, researchers said. For instance, if a scoliosis patient requires two surgeries performed about 15 days apart--a planned readmission--that is counted against the 30-day window. If that spine surgery patient comes back for a hip surgery--an unrelated readmission--the hospital could be penalized. If the operation is canceled or rescheduled for an unpreventable reason, say, if the spinal surgery is postponed due to an irregular heart rate, the hospital could pay for that, as well.

Of the 281 patients readmitted within 30 days of discharge, 25 percent (69) of those readmissions should not have been counted against the hospital--39 cases that were planned readmissions for staged procedures, 16 cases that were unrelated and 14 cases that were canceled or rescheduled due to unpreventable reasons. The 4.9 percent readmission rate was more like 3.7 percent, according to HealthDay News.

To combat the "pitfalls in the current calculation of readmission rates," Loyola University Medical Center neurosurgeon Beejal Amin said they are working on modifying the algorithm to make it more clinically relevant.

"Readmissions should be determined not only by hospital readmission but also require the presence of a diagnosis code that indicates a spine-related complication. This will help prevent false-positive readmission classification," study authors wrote.

On the flip side, the exaggerated readmission rates also mean that spinal surgeries may be more successful than reported in public statistics, according to a UCSF statement in April.

"Publicly reported 'all-cause' readmission rates may not be realistic," said Praveen Mummaneni, codirector of the Spinal Surgery and UCSF Spine Center.

For more information:
- here's the study announcement
- see the UCSF statement
- read the HealthDay article

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