Same-hospital readmission rates aren't a reliable predictor of all-hospital admission rates and put hospitals at a disadvantage since the Centers for Medicare & Medicaid Services considers the latter when determining readmission penalties, according to new research presented at the 2013 Conference of the American College of Surgeons (ACS).
Researchers with the University of Michigan analyzed three years' worth of data on more than 600,000 Medicare patients undergoing colectomies, hip fracture repairs or coronary artery bypass grafts. About 13 percent of these patients had a readmission within 30 days, but only about two-thirds of the 13 percent were readmitted to the same facility, according to the research announcement.
The researchers used the patient data to produce risk-adjusted same-hospital and all-hospital readmission rates, and then ranked readmission rates from lowest to highest divided into five groups, or quintiles. When they compared the two rates, more than 40 percent of hospitals were in different quintiles for same-hospital than for all-hospital. The highest level of reclassification was found in the median group. More than 50 percent of hospitals in this group were reclassified when the research team adjusted for all-hospital readmission rates.
"Unless you are a top or bottom performer for readmissions, your same-hospital readmission rate may be very misleading," study coauthor Andrew Gonzalez, M.D., a research fellow in vascular surgery at the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, said in the research announcement. "That's why using the same-hospital readmission rate is an unreliable predictor for your all-hospital readmission rate, but that rate is exactly what CMS penalizes hospitals for."
Hospitals cannot effectively reduce readmissions if they are working with incomplete information, according to Gonzalez. "Under the current model, hospitals are attempting to solve the readmissions problem without having all the puzzle pieces," he said. "They know about readmissions to their own facilities, but not about readmissions to other facilities."
Two-thirds of hospitals nationwide are expected to receive readmission fines in the upcoming year, a payment reduction of more than $200 million, although 1,371 hospitals will receive a lower fine than in the first round of penalties, FierceHealthcare previously reported.
To learn more:
- here's the ACS research announcement