Johns Hopkins study questions link between readmissions, care quality

Readmissions are a common metric used to penalize hospitals, but new research suggests that some hospitals with high readmission rates may be saving more lives.

Researchers at Johns Hopkins studied three years of public hospital data gathered by the Centers for Medicare & Medicaid Services, and compared the readmission rates with mortality rates for six conditions: heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease and coronary artery bypass. The hospitals with the highest readmission rates had better mortality rates for COPD, stroke and heart failure, according to the study.

CMS began using readmissions to punish hospitals in 2012, FierceHealthcare previously reported, with the goal of improving care and making it more cost-efficient. Daniel Brotman, M.D., the study’s lead author and director of the hospitalist program at Johns Hopkins Hospital, commended CMS’s goal in an announcement of the findings, but said that using readmissions as a quality measure is “inherently problematic.”

“High readmission rates could stem from the legitimate need to care for chronically ill patients in high-intensity settings,” Brotman said. “It’s possible that global efforts to keep patients out of the hospital might, in some instances, place patients at risk by delaying necessary acute care.”

The Johns Hopkins study is not the first to call CMS’ use of readmission rates as a tool for punishment into question. The American Hospital Association has also called for changes to the Hospital Readmissions Reduction Program, as has the National Quality Forum, FierceHealthcare previously reported. This year, more than half of the hospitals in the U.S. were hit with penalties from CMS for their readmission rates.

Brotman also expressed concern with the way readmissions are included in CMS’ star ratings, according to the announcement. He said that giving readmission rates and mortality rates unfairly skews data.