To Lower Readmission Rates, Hospitals Need Better Data

Since October 2012, the Centers for Medicare & Medicaid Services (CMS) has employed a provision of the Patient Protection and Affordable Care Act (ACA) to financially penalize hospitals with excessive readmission rates.

However, most hospitals use billings data to track readmissions — which means they can only identify patients readmitted to their own facilities — and research findings presented at the 2013 Clinical Congress of the American College of Surgeons indicate that those same-hospital rates are poor predictors of all-hospital rates.

“With increasing penalization for readmissions rates, hospitals need complete information to effectively target areas for quality improvement,” said study co-author Andrew Gonzalez, MD, JD, MPH, a research fellow in vascular surgery at the Center for Healthcare Outcomes and Policy at the University of Michigan in Ann Arbor. “Under the current model, hospitals are attempting to solve the readmissions problem without having all the puzzle pieces—they know about readmissions to their own facilities, but not about readmissions to other facilities.”

Gonzalez and his colleagues evaluated 3 years of data for 660,700 Medicare patients who had coronary artery bypass grafts, hip fracture repair, or colectomy. Roughly 13% had at least 1 readmission within 30 days of discharge. Two-thirds of the group was readmitted to the same hospital, and the remainder went elsewhere.

The researchers then generated risk-adjusted rates of same-hospital and all-hospital readmissions by creating 5 quintiles that ranked hospitals from lowest to highest readmission rates in both categories. Comparing the 2 sets of quintiles, the study authors found that 42% of hospitals fell into different quintiles. For example, approximately 24% of top-performing hospitals in the same-hospital group were reclassified when the rankings were based on all-hospital readmission. Overall, hospitals in the median quintile were most likely to be reclassified, with 55% moving based on all-hospital readmissions rankings.

“Unless you are a top or bottom performer for readmissions, your same-hospital readmission rate may be very misleading,” Gonzalez said. “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.”

Gonzalez said the annual hospital-specific report furnished by CMS provides dated information. To decrease readmissions and improve care quality, hospitals need access to real-time data, he said. Therefore, the researchers suggested that a surgical quality improvement collaborative might exchange information quickly and easily.