More on Hospital Readmissions

Hospital readmissions, hospital readmissions.  So much research with such uncertain overall results, but much of which continues to point to serious problems with the CMS and other punitive programs aimed at reducing inappropriate readmissions.  A study reported in the Journal of the American Medical Association does little to ameliorate the concern that these programs are ill-designed to achieve their objectives.   (JAMA Article)   This study examined the relationship between all-cause risk-standardized 30-day hospital readmission rates and 30-day all-cause, risk standardized mortality rates for Medicare beneficiaries between 2005 and 2008.  The index admission diagnoses were acute heart attack, heart failure and pneumonia.  The theory being tested is that hospitals with more readmissions are probably delivering less quality and therefore have higher mortality rates.  The researchers found that the average mortality rate and readmission rate was 16.6% and 19.9%, respectively, for heart attack, 11.2% and 24.6% for heart failure and 11.6% and 18.2% for pneumonia.  In an analysis of the covariation, the researchers found no significant correlation between mortality and readmissions for heart attack and pneumonia and only a very weak one for heart failure.  No difference was found according to various characteristics of hospitals.  Some comfort can be taken in that it would appear that hospitals can lower readmissions without necessarily raising mortality, but at least according to one common measure of quality–mortality rates– there is no reason to think that lowering readmissions will improve that measure.