CMS needs to issue penalties for patient deaths not just readmissions


Thirty-day readmission rates are one of the most heavily-weighted measures used by federal agencies to assess hospitals’ care quality, but new research indicates Medicare should give the same weight to patient mortality during those first 30 days as well.

Financial penalties for hospitals that have an excessive number of patients die within a month of hospitalization could make a negative or positive difference for 1 in 3 hospitals, according to research published in JAMA Cardiology.

Researchers from Michigan Medical School and VA Ann Arbor Healthcare System found that 17 percent of hospitals face heavy readmission penalties but are ahead of the curve on keeping patients alive. They found another 16 percent are reaping the financial benefits that come with low readmission rates while their patients are at heightened risk of death in the next 30 days.

"Under most circumstances, hospital patients would much rather avoid death than readmission," senior author Scott Hummel, M.D., a heart failure cardiologist, said in a statement. "But the incentive to prevent death in the first 30 days after a hospitalization is 10 times less than the incentive to prevent a return hospital visit."

The findings shouldn’t be taken as evidence that readmission penalties aren’t effective at improving care quality, the authors said, although they noted it might serve as a more effective metric if Medicare refined the measure to encompass readmissions for the same condition that caused the hospitalization, rather than for all causes.

Groups such as the American Hospital Association have also argued the penalties are unfair to hospitals serving lower-income patients.

Moreover, Hummel said, while readmissions should be avoided wherever possible, putting so much emphasis on preventing them can create a mindset that obscures the necessity of readmissions when the alternative is death.

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