Becker's Clinical Quality & Infection Control

12 REDUCING READMISSIONS Should Readmission Rates Be Used to Measure Hospital Quality? Study Casts Doubt By Brian Zimmerman H ospitals with higher readmission rates are actu- ally more likely to have lower mortality scores for patients treated for heart failure, chronic obstructive pulmonary disease and stroke, according to a study published in the Journal of Hospital Medicine. The study comes from a group of physicians and re- searchers with Johns Hopkins University in Baltimore. For the study, the group examined three years of CMS data on hospitals from across the United States. The group compared data on readmission rates and mortality rates across six conditions — heart attack, pneumonia, heart failure, stroke, COPD and coronary artery bypass — from nearly 4,500 acute care facilities. Analysis revealed high rates of readmission were as- sociated with better mortality scores for COPD, stroke and heart failure. The study's findings suggest quality measures used by CMS to save money and promote more efficient care may be problematic. Daniel Brotman, MD, a professor of medicine at Johns Hopkins and the study's lead author, said he commends CMS for working to reduce the cost of healthcare, "but using readmission rates as a measure of hospital quality is inherently problematic. High readmission rates could stem from the legitimate need to care for chronically ill patients in high-intensity settings." Dr. Brotman cited the CMS overall hospital quality star ratings as "particularly problematic," stating that giving readmissions and mortality equal weight when ranking for quality skews data against hospitals. n Every State But 1 Lowered Hospital Readmissions Since 2010, CMS Data Show By Heather Punke B etween 2010 and 2015, national readmission rates fell 8 percent, thanks in part to the implementation of the Hospital Readmission Reduction Program and other CMS-led quality improvement initiatives, according to a September blog post by two CMS officials. In fact, Medicare 30-day readmission rates fell in 49 states and Wash- ington, D.C., from 2010 to 2015. Only Vermont saw readmissions increase during that time period, albeit readmission rates in the state rose less than 1 percent (0.7 percent). Many states made great strides in readmission rate reduction, as 43 states saw readmission rates fall by more than 5 percent, and 11 states saw a greater than 10 percent reduction. Hawaii saw the largest fall, tallying a 13.4 percent reduction in read- missions since 2010. ese reductions mean Medicare beneficiaries have avoided roughly 565,000 readmissions since 2010, according to CMS estimates. CMS focuses on reducing 30-day readmissions because they are costly — they account for $17 billion in Medicare spending each year, according to the blog post — and "they are oen a sign of poor qual- ity care," wrote Patrick Conway, MD, principal deputy administrator and CMO of CMS, and Tim Gronniger, CMS' deputy chief of staff. "e goal of [readmission reduction] efforts is to spend our health- care dollars more wisely to promote better care for Medicare benefi- ciaries and other Americans across the country," the blog post reads. However, a study published in the Journal of Hospital Medicine in September found hospitals with higher readmission rates are more likely to have lower mortality scores for heart failure, chronic ob- structive pulmonary disease and stroke patients. n

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