A new study presented at the 2013 Clinical Congress of the American College of Surgeons suggests that the current practice of considering same-hospital readmission rates by the Centers for Medicare & Medicaid Services (CMS) in penalizing readmission to hospitals is unreliable compared in predicting all-hospital readmission rates.
"With increasing penalization for readmissions rates, hospitals need complete information to effectively target areas for quality improvement," said study coauthor Andrew Gonzalez, MD, JD, MPH, a research fellow in vascular surgery at the Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor. "Under the current model, hospitals are attempting to solve the readmissions problem without havng all the puzzle pieces-they know about read-missions to their own facilities, but not about readmissions to other facilities."
For the University of Michigan study, researchers evaluated three years of data on 660,700 Medicare patients undergoing one of three major surgical operations: coronary artery bypass grafts, hip fracture repair, and colectomy. Within this group, 86,200 patients (about 13 percent overall), had at least one readmission within 30 days of their operation. Within that 13 percent, 54,264, or about two-thirds, were readmitted to the same hospital.
"When you look at reclassification over all of the quintiles of performance, the take home message is that about 42 percent of hospitals reclassify," Dr. Gonzalez said. "Unless you are a top or bottom performer for readmissions, your same-hospital readmission rate may be very misleading. That's why using the same-hospital readmission rate is an unreliable predictor for your all-hospital readmission rate, but that rate is exactly what CMS penalizes hospitals for."
The researchers conclude that in order to decrease readmissions and improve quality of care, hospitals need to have access to real-time data. This access could come in a number of forms, including a surgical quality improvement collaborative where information is quickly and easily exchanged among participants.
"As it currently stands, CMS sends institutions annual hospital-specific reports," Dr. Gonzalez explained. "These reports include the institution's all-hospital readmission rate, and, moreover, the provider IDs for all the other hospitals to which an institution's patients were readmitted. Yet upon receipt, the information is already a year old. The incorporation of real-time data might significantly improve the efficiency of the quality improvement cycle."