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Hospital Readmission Penalties Suck

By May 2, 2017Commentary

That’s right I meant what I said in the title.  I have been carping about the Medicare readmissions penalties since the program started and the research pretty much confirms how bad it is, including a recent analysis in the Journal of the American Medical Association, Internal Medicine.  (JAMA Int. Med. Study)   One of the conditions for which excessive readmissions are penalized is myocardial infarction or heart attack.  The authors attempt to understand if there is a relationship between 30-day readmission performance and objective measures of care quality and long-term clinical outcomes.  Over 176,000 patients at 380 hospitals.  Smaller hospitals were generally excluded.  CMS’ excess readmission rate was used for each of the hospitals.  Standard process of care measure performance was evaluated via a pre-existing registry.  Clinical outcomes included one-year all cause mortality or readmission.   43% of the hospitals had been deemed by CMS to have excessive readmissions.  As other research has shown, there appeared to be demographic and health status factors that account for some of this performance, factors which CMS does not adjust for.  In regard to most of the process of care measures, there was no difference in performance of hospitals across the readmission rate metric that CMS uses; i.e. there was no correlation.  Following the initial 30-day period following discharge, there was no long-term risk association between the CMS readmission score and the clinical outcomes of mortality and readmission.  Like all government bodies, CMS is stubborn as hell, believing in its own infallibility.  It would be nice if it would dump or revise the program, but don’t expect it to recognize a mistake.

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