Readmission Penalties and the Best-Laid Plans
Careful data analysis revealed that between 1/5 and 1/4 of hospitalized Medicare patients were readmitted within 30 days of discharge. Further examination revealed that many of these episodes were potentially avoidable and due to:
- Poor communication,
- Inadequate transitions of care, or
- Sub-optimal treatment.
The Centers for Medicare and Medicaid Services (CMS) began a focused program of penalizing hospitals for “excessive” readmissions, targeting high-volume, high-cost diagnoses. As a result, a massive effort has been expended to better understand the reasons for readmission and strategies most likely to prevent them.
A Landmark Improvement in Quality? Somewhat, but in reality readmission is a metric of utilization, not necessarily of quality. For example, studies of readmissions for congestive heart failure, the most expensive DRG in the Medicare system, reveal an inverse relationship between frequency of readmission and mortality. In other words, in order to be readmitted, one must be alive, and those centers that succeed in reducing mortality do so at the expense of providing hospital care for their sickest patients. More careful examination of the data reveals that much of the variance in readmission rates is not due to patient characteristics or even therapeutic decisions, but social factors uncontrolled and uncontrollable by the medical professional or healthcare system such as:
- Socio-economic status,
- Home support,
- Neighborhood resources, etc.
The CMS decision that hospitals serving low-income people “should not be held to a different standard,” has had the consequence of penalizing medical centers that care for low-income, high-risk populations—centers that are most in need of additional, rather than restricted resources. These penalties have resulted in a reduction in readmissions and an enhanced emphasis on transitions of care and hospital engagement with community resources. However, they have directed needed resources away from institutions that serve the populations at highest risk. Health policy in medicine is best informed by careful consultation with those that have boots “on the ground” actually caring for the patients.
To learn more about the rapidly evolving healthcare regulatory environment and leading your organization toward becoming the regional leader in high quality care, join us October 6th on the Columbia University Medical Center campus for our annual Network Day Event ~ details at http://columbiaheartsource.org/annual-network-day