The Centers for Medicare & Medicaid Services dings hospitals with high 30-day readmission rates, withholding millions in payments as punishment.
But it may be time to consider using a shorter window of time to measure quality, according to a new study.
Researchers at Beth Israel Deaconess Medical Center studied admissions data on 822 adults who were readmitted to 10 academic medical centers and found that early readmissions were far more likely to be preventable than later readmissions closer to the 30-day mark.
The study found that 36.2% of early readmissions—defined as readmission within seven days of discharge—were preventable, compared with 23% of readmissions between eight and 30 days after discharge. Early readmissions are also more easily addressed by hospitals themselves, according to the study.
"Early readmissions were more likely to be preventable and amenable to hospital-based interventions," the researchers said. "Late readmissions were less likely to be preventable and were more amenable to ambulatory and home-based interventions."
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This adds further fuel to research that has raised questions about the value of penalties based on 30-day readmission rates. Studies have suggested CMS' penalties tied to hospital readmissions may be counterproductive, as the funding cuts could make it harder for these hospitals to undertake quality improvement initiatives. A study from UCLA researchers late last year linked the readmission penalties with higher death rates.
The Beth Israel researchers said that because the early readmissions are more likely to be preventable by the hospital, they may be a better indicator of the quality of care provided instead of the 30-day window.
Improved care coordination is a key solution to reducing readmissions, and the researchers note that this is especially crucial in the early period after discharge.
Major hospital groups, such as the American Hospital Association, have called for changes to the federal readmission reduction program. The group said readmission penalties based on a 30-day window may punish hospitals for factors outside of their control.