The effort to reduce hospital readmissions, culminating in Medicare’s penalties for hospitals with “excessive” readmissions, is based on avoidance of patient harm and improvement in coordination of care outside the hospital. Controversy surrounds defining an avoidable readmission and what steps will best encourage better transitional care. The Commonwealth Fund convened a group of experts to get their views on the subject. (Commonwealth Brief) The panelists began by suggesting a broader focus on patient care that would include measures regarding avoidable admissions and longer period of care following hospitalizations. One concern expressed was that the current narrow focus on readmissions could deter needed admissions, readmissions and days in the hospital. The current Medicare measures don’t give hospitals any useful information about where their excess readmissions may be or how they could be avoided. Hospitals are also being held accountable for care after discharge over which they have little or no control, including in many cases the patient’s own actions. An ongoing concern is whether the current approach unfairly punishes hospitals with large numbers of low income patients and panelists suggested only comparing these hospitals with each other. And the current CMS program ignores a general increase in performance and continues to punish relative lower performance. All of these concerns seem well-justified and we have long advocated that CMS abandon its current program and instead rely on review of each readmission to determine appropriateness. This would help hospitals identify specific causes for specific readmissions and programs that address those causes.
