Two new studies that evaluate attempts to improve surgical outcomes call into question the effectiveness of at least one of the key metrics for care quality performance in the current pay-for-performance model used to evaluate hospitals.
Unplanned hospital readmissions for patients following surgery are primarily due to new, surgical complications rather than the worsening of patients' previous medical issues, according to the first study, which was published in the Feb. 3 issue of the Journal of the American Medical Association.
Researchers tracked the outcomes of patients for 30 days following nearly 500,000 operations at 346 hospitals. Overall, the readmission rate was 5.7 percent, and surgical site infections (SSI) were the most common reason for readmission, occurring in 19.5 percent of postoperative readmissions. In terms of timing, researchers found no particular point in the 30 days after surgery when readmission was most likely to occur.
Based on the study's findings, the authors write that "readmission rates may be difficult to reduce until effective strategies are put forth to reduce common complications such as SSI," and therefore postoperative readmissions "may not be an appropriate measure for pay-for-performance programs but rather better suited as measure for hospitals to track internally."
This is in stark contrast to the Centers for Medicare & Medicaid's policy of offering financial incentives to hospitals that effectively reduce preventable readmissions--and penalizing those with the highest readmission rates. This year's CMS penalties for excessive readmissions reached a record high, with more than 2,600 hospitals set to be hit with payment cuts, according to FierceHealthcare.
The policy has been criticized by some who say CMS' formula of dividing the number of readmissions by overall discharges is fundamentally flawed, FierceHealthFinance has reported. In fact, many readmissions may "be beyond a hospital's control," according to another recent study from the American Journal of Managed Care.
Surgical outcomes also may not improve simply due to participation in the American College of Surgeons National Surgical Quality Improvement Program, according to another study the in most recent issue of JAMA. The program, in place since 2000, required nurses to record data about and evaluate every operation conducted at particpating hospitals.
But participating hospitals didn't report better patient outcomes or lower Medicare payments than those at non-participating hospitals, suggesting that "feedback on outcomes alone may not be sufficient to improve surgical outcomes," the study says.