Hospitals: Readmission rate penalties misguided

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

David J. Shulkin, M.D., head of Morristown Medical Center in New Jersey, says that while it's important to lower readmission rates, a hospital's readmission rate is only one "piece of a larger puzzle, according to Morristown is only one of two hospitals in New Jersey escaping the new penalty being imposed by CMS. Sixty-two others were not so lucky.

The Affordable Care Act requires CMS to impose penalties on hospitals whose readmission rates for heart failure, heart attack and pneumonia are worse than the national average. CMS recently announced that two-thirds of the hospitals in the United States would be assessed the penalty in the form of reduced Medicare reimbursement.  

But readmission rates can't be viewed in a vacuum, according to Dr. Thomas MacKenzie, head of quality for Denver Health, a safety net hospital that also escaped the penalty. His hospital enjoys lower readmission rates in part because it's an integrated health system that enables it to treat more patients in an outpatient setting. It was also an early adopter of EHRs, which enables it to share data to keep admissions rate down, according to

"It's a bit of a leap to say that one hospital's readmission rate being different from another reflects a difference in quality and care," he said. "Only a proportion of [readmissions] within 30-days are preventable. We think probably a quarter of them are preventable, at most."

Shulkin concurs.

"I think the more appropriate (indicators) are the ones that deal with the total cost of care, population health measures, management of chronic disease, management of mortality, management of adverse events and patient satisfaction," Shulkin said. "I think those really round out the important measures."

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