Doctors: Readmission penalties do more harm than good

As hospital leaders brace for about $280 million in payments from more than 2,200 hospitals beginning next month, some physicians warn the new penalties won't improve care.

Although hospitals will face up to 1 percent cuts in Medicare payments for high readmission rates, many factors sending congestive heart failure patients back to the hospital are not related to treatment provided at the facility, Frank Mongillo III, a Connecticut internist, wrote today in The Register Citizen.

Rather, readmissions largely stem from what happens outside the hospital walls, where patients need to adhere to their medications and dietary guidelines. Efforts to shorten length of stays also drive readmissions, as doctors don't have enough time to stabilize a patient's treatment, he noted.

While readmission penalties can promote improvements in follow-up care, such interventions may not prevent the sickest patients from readmitting, Mongillo pointed out.

Moreover, hospitals that have spent a lot of time and money on readmission reduction efforts have yet to see improvements, Westby G. Fisher, an internist and cardiologist at Illinois' NorthShore University HealthSystem, wrote in MedCity News.

So instead of hiring more administrators and nurse coordinators, with expensive salaries and benefits, he recommended hospitals help front-line workers already on the job better care for their patients.

"[M]y bet is that hospitals would do way better off financially in the long run if they stopped trying so hard to follow unproven legislative initiatives," Fisher said.

Mongillo agrees. "These cuts in Medicare will threaten our system of healthcare delivery and leave fewer choices for doctors and patients. The result will be long waits for treatment and less availability of care," he said.

Similarly, executives of two hospitals that have dodged the new penalty maintain a hospital's readmission rate is not necessarily the best way to measure care.

For more:
- read the Register Citizen op-ed
- here's the MedCity News piece