Medicare readmission rates offer incomplete picture of hospital quality

Condition-specific readmission rates do not offer a fair proxy for overall hospital quality, according to a new analysis of federal data.

study published this week in the Annals of Internal Medicine examines the relationship between 30-day readmission rates reported to Medicare compared to readmissions among non-Medicare patients. Researchers found the condition-specific ratios, covering heart failure, heart attack and pneumonia among Medicare beneficiaries, to be poorly correlated with readmissions related to other conditions or patient populations.

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While the reporting system for Medicare offers some insight into hospital quality, it provides an “incomplete picture” of a hospital's overall quality, according to the study’s senior author, Robert W. Yeh, M.D., director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center.

“It’s a little bit like issuing a final grade based on a few homework assignments and not a full semester’s worth of work,” he said in a statement.

The utility of readmission rates as a quality measure has come into question since the implementation of Medicare’s Hospital Readmission Reduction Program. Previous studies have found that the program unfairly penalized a large number of hospitals and may have even led to higher death rates for patients with heart failure.

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In the most recent study, researchers found that 29% of the hospitals penalized for readmissions under the current system would not be penalized if the quality metrics included patients from a broader sample than the conditions currently monitored. Broadening the scope of the metrics to include the entire patient population of the hospitals, rather than Medicare patients alone, would eliminate penalties on 40% of hospitals that were penalized.

“This tells us that similar hospital or patient characteristics may influence readmissions more than similar disease conditions,” said the study’s first author, Neel Butala, M.D., an investigator at the Smith Center and a cardiology fellow at Massachusetts General Hospital, in the statement.