Is The Focus On Readmission Rates Misguided?
By Monica Oss Open Minds March 30, 2012
Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, www.openminds.com. All rights reserved.
While the attention on health care policy has been focused on universal coverage in reform legislation and the pending Supreme Court decision, the issue of costs continues to be the driver of health care practice. Two health care cost factors get my attention when I review spending data – the cost of managing chronic diseases and the cost of hospital readmissions.
I’ve covered the current data and policies on the readmissions issue extensively (see Financing Change the Key to Reducing Readmissions all members and The Answer Is… all members). And, I’m not alone in identifying readmissions as a key to reducing costs – there are a number of current and pending initiatives focused on this issue (see Payment Policy For Inpatient Readmissions premium members, CMS Launches Program To Reduce Hospital Readmissions By Linking Nursing Homes With Care Coordination Partners premium members and CMS Value-Based Purchasing to Reward Hospitals for Performance premium members).
But, there is also a counter view. In The New England Journal of Medicine’s recent article, Thirty-Day Readmissions — Truth and Consequences, authors Karen E. Joynt and Ashish K. Jha laid out three reasons why the emphasis on 30-day readmissions may be misguided:
- Readmission rates are a poor marker of hospital performance, driven more by who the patients are, and how many resources the surrounding community has – both of which are outside a hospital’s control.
- There are better policies than discharge planning and care coordination for achieving reduced readmissions – in some cases, improving care coordination and access to follow-up care has been shown to have the opposite effect and increase readmissions.
- When hospitals spend money and energy on reducing readmissions, they may forgo quality-improvement efforts related to more urgent matters – such as preventable deaths from acute myocardial infarction, congestive heart failure, and pneumonia.
The authors’ conclusion in the article is an interesting perspective:
The metrics that policymakers choose to use in rewarding and penalizing hospitals have a profound effect not just on what hospitals do but on what they choose not to do. The financial penalties for high readmission rates dwarf the penalties for poorer care, including those for high mortality rates and unsafe care. The current policy sends a clear signal about where hospitals should focus their efforts. We are asking U.S. hospitals to spend their limited resources on ensuring that patients are not readmitted as many as 4 weeks after discharge — events that are largely outside the hospitals’ control.
But I’m not sure I’m convinced. I think the purpose of the policy is to encourage consumer-centric coordination of care beyond the hospital walls. And, we’ve seen in the recent coverage of the CMS experiment with bundled payment rates, that those “incentives” can work (see Medicare Demonstration Project Results Are In – Only Winner Was Bundled Payments all members).
But, what do you think? Is the focus on readmissions the wrong focus? Share your perspectives with me at openminds@openminds.com.
Sincerely,
Monica E. Oss
Chief Executive Officer, OPEN MINDS