In December, Medicare released data on the best and worst hospitals for hip and knee replacements. Providers are now debating the deeper meaning of that data, according to the Philadelphia Inquirer.
The figures indicate that many hospitals with high replacement volumes also have high complication and readmission rates. On a surface level, it might appear that these hospitals don't perform quality joint replacements, but hospital officials say it's more complex, according to the article. For example, high readmissions could be due to a sicker, lower-income patient population--making them less likely to closely follow post-discharge instructions.
The Medicare data released only cover patients with traditional fee-for-service Medicare, and are risk-adjusted, so a hospital with an older, sicker patient base has more room before the agency considers its readmissions and complications are worse than the norm, according to the article.
The program used to analyze the Medicare data takes specific hospitals' patient populations into account, said Lisa Suter, associate director of the program, so "[y]ou still get a very important sense of how sick that hospital's patients are, even if you're not necessarily getting a precise sense of how sick one patient is."
However, improper record-keeping could also affect readmissions data, according to James Saucedo, lead author of a Northwestern University study on the subject. At an urban hospital with high patient volume, administrators might not have the time or resources to track patient comorbidities, or medical conditions other than the reason for admission, Saucedo stated.
As a result, he said, a patient returning for that unrelated condition would appear to be a readmission, and "[t]hese institutions, which we would expect to be among the best, they're going to look terrible."
Another mitigating factor is that readmissions data do not necessarily have any bearing on whether a patient is able to walk without pain, Andrew Star, M.D., chief of orthopedics at Abington Memorial Hospital, told the Inquirer. "My concern with using readmission as a criteria is it doesn't really measure patient outcome per se," Star said. "It's more of a financial parameter."