NQF endorses readmission measures

Falling in line with national initiatives, the National Quality Forum endorsed two new measures for all-cause unplanned readmissions Tuesday.

One of the endorsed measures, developed by National Committee for Quality Assurance (NCQA), counts the number of inpatient stays for adult patients to predict the probability of an acute readmission. The second measure is a risk-adjusted readmission rate for surgery/gynecology, general medicine, cardiorespiratory, cardiovascular and neurology. Developed by the Centers for Medicare & Medicaid Services and Yale University, the measure estimates the risk-standardized rate of unplanned, all-cause readmissions.

Many providers have criticized national measures of readmissions as an indicator of quality. For example, at the University of California, San Francisco Medical Center, researchers found that all-cause readmissions inflated rates by 25 percent because they fail to differentiate between planned, scheduled, staged and unplanned surgeries for complications.

NQF said the two newly endorsed measures account for multiple factors that affect readmissions, including the complexity of the medical condition, effectiveness of inpatient treatment and care transitions, patient adherence to treatment plans, patient health literacy and availability of community-based services.

"The recently endorsed NCQA and CMS/Yale measures will focus attention on the multiple patient and system factors which influence re-hospitalizations," Sherrie Kaplan, assistant vice chancellor for healthcare measurement and evaluation and professor of medicine at the University of California, Irvine School of Medicine, said in a statement. "These measures will hopefully encourage increased communication and collaboration among all the stakeholders needed to reduce avoidable re-hospitalizations."

Costing about $15 billion each year, readmissions are the target of federal programs tied to reimbursements. One in every five Medicare beneficiaries ends up back in the hospital within 30 days, according to NQF President and CEO Janet Corrigan.

The U.S. Department of Health & Human Services has set a goal of cutting readmissions across all settings by 20 percent in 2013 compared to 2010 rates as part of its Partnership for Patients campaign.

To learn more:
- here's the NQF statement
- see the NQF-endorsed standards

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