News: Readmission rates drop across the U.S.

With Affordable Care Act and Hospital Readmissions Reduction Program efforts, 49 states and the District of Columbia have seen a drop in readmission rates, according to CMS. Since 2010, Medicare 30-day readmissions rates declined by more than 10% in 11 states and by more than 5% in 43 states. Nationally, from 2010 to 2015 Medicare readmission rates have decreased by 8%, says CMS. In 2015, hospitals avoided 100,000 readmissions, reaching a grand total of 565,000 avoided readmissions since 2010.

While CMS emphasizes readmissions reductions in its efforts, researchers and physicians at Johns Hopkins Hospital challenge the notion of readmissions as an accurate measure of quality care. In the study published this month in the Journal of Hospital Medicine, hospitalist Daniel J. Brotman, MD, and his colleagues examined nearly 4,500 acute-care hospitals’ readmission rates and compared them with those hospitals mortality rates in six areas used by CMS—heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease (COPD), and coronary artery bypass.

Researchers found that hospitals with the highest rates of readmission were more likely to show better mortality scores in patients treated for heart failure, COPD, and stroke. The results indicate that patients treated at hospitals that had more readmitted patients had a fractionally better chance at survival than patients who were cared for at hospitals with lower readmission rates.

“When we did deep dives into causes of readmissions for individual patients, sometimes we saw situations in which providing more comprehensive, detailed, or sophisticated care was leading to readmissions,” said Brotman in an interview with HealthLeaders Media.  “The defects that lead to readmissions are usually not related to the care provided during the hospitalization.”

CMS Star Ratings ranks readmissions similarly to mortality, which is a particular concern in that the agency seems to be using readmissions as a quality metric, Brotman says. “Certainly readmissions are a measure of how much care a patient is getting in the inpatient setting to some extent, but are they a measure of quality or do they measure something else?”

One of the ways to prevent a readmission is to keep someone out of the hospital at all costs, which is not always good for patient care, says Brotman. Readmissions, like length of stay, should be a utilization measure, not a quality measure, he says.

“We shouldn't admit patients who don't really need to be in the hospital,” says Brotman. “But we also shouldn't be incentivizing hospitals to do their best to turn away patients who do need hospitalization regardless of whether they've recently been hospitalized.”