Better Approaches to Measuring Hospital Readmission Issues

We have long thought that CMS’ hospital readmission penalty program is moronic and unfair and a study carried in Health Affairs give further support to that view.   (HA Article)   The CMS program is built on a 30-day readmission measure, with the assumption that hospitals are capable of controlling care in the time frame after discharge.  As the study points out, there is no empirical evidence supporting this assumption.  The researchers examined what proportion of variation in hospital readmission rates appeared to be the responsibility of hospitals and what was due to other factors, such as patient or community demographics.  They used all-payer data sets from four large states to conduct the analysis.  They tested a variety of post-discharge intervals, from one to 90 days, to ascertain the variation across hospitals in those intervals, looking generally and at readmissions for the specific diagnoses included in the CMS program.  The overall 30-day readmission rate was 15.5%, with unplanned readmissions represented 90% of all readmissions.  The thirty-day readmission rate was 17.5% for heart attacks, 24% for heart failure, 17.6% for pneumonia.  Patients in low-income and rural areas had much higher readmission rates.  The variation across hospitals was relatively small at all intervals, but was most significant in the first few days after discharge.  By thirty days after discharge, the current CMS time-period, inter-hospital variation had basically become quite low and was much less of a factor than geo-demographic ones.  The conclusion of the authors was that if CMS is trying to address readmissions that are within the hospital’s control, it should change the measuring period to 5 to 7 days after discharge.  As I have said repeatedly, an even better idea is to look readmission by readmission and determine which ones actually were the avoidable fault of the hospital.