For years, we've been hearing how high readmission rates at hospitals are a sign of poor performance, so much so that last year, the Centers for Medicare and Medicaid Services added readmission rates as one of the hospital performance measurements listed on its Hospital Compare website. However, a new analysis of such rates by doctors at the Cleveland Clinic published in the New England Journal of Medicine this week--at least for heart failure patients--seemingly turns that logic on its head.
The study's authors instead point out that higher readmission rates for such patients have been associated with lower risk-adjusted 30-day mortality. As reported by HealthDay News, according to Hospital Compare data, the national 30-day readmission rate for heart failure is 24.7 percent, compared with 28 percent at the Cleveland Clinic. However, Hospital Compare data also shows that the 30-day death rate for Medicare patients with heart failure to be just over 11 percent, while Cleveland Clinic's death rate stands at just under 9 percent.
Drs. Eiran Gordeski, Randall Starling and Eugene Blackstone of the Clinic all maintain, not only that the lower mortality rate automatically makes a greater portion of patients eligible for readmission, but that planned readmissions for procedures or surgeries often are for appropriate care, not poor performance.
"Are all readmissions bad readmissions?" the authors ask. "Is the rate of readmission for any reason 30 days after hospitalization the most appropriate index of poor quality of care? We believe that a nuanced interpretation of the CMS Hospital Compare data is in order."
To learn more:
- here's the NEJM analysis
- read the HealthDay News piece, via Businessweek