Blog | Wednesday, September 28, 2011

Readmission after hospital discharge is not an indication of poor care


Hospitals across the country are working on quality initiatives to reduce re-admissions to hospitals. There are consultants, conferences, forums, meetings, physicians, nurses and administrators who are spending hours upon hours (and lots of $$$) to find ways to keep patients who have been discharged from being readmitted within 30 days. Why all of this activity? It is one of the quality measures that is being tracked by Centers for Medicare and Medicaid Services (CMS), and decreased reimbursement will be next if a patient is readmitted to any hospital within 30 days of a discharge. The diagnosis doesn't matter.

A new study shows all of this focus and cost may not be worth it. Readmission after a hospital discharge may not be an indication of poor care.

The study, published in the Canadian Medical Association Journal looked at 4,812 patients and had medical experts review the cases of the 649 who needed urgent readmission within 6 months. (Not one month as we are measuring). They found that avoidable readmissions were relatively uncommon. Only 16% could have been prevented by better care, oversight or management of their condition, and a tiny number of readmissions within 30 days, as we are tracking, were potentially avoidable.

This makes sense to me. They found patients who were readmitted had more previous hospital admissions and more extensive health issues. And the patients in this study were even younger than the typical Medicare patient. No one wants to be in the hospital. Doctors do not want to admit patients unless they are very, very ill. Patients who have many medical problems like heart failure, strokes, liver failure, cancer, etc. tend to decline in health as time goes on. Outpatient care and case management efforts cannot always prevent declines. The study points out that we might be measuring the wrong thing if we think it is a measure of medical quality.

They did find some urgent readmissions were avoidable. But it didn't vary by hospital ranking so either all hospitals are performing the same or it isn't really a measure of quality.

Message to CMS: Readmission cannot be determined on the basis of administrative data alone and it requires subjective judgment, detailed patient data, multiple reviewers and an analysis that accounts for differing reviewer accuracy when collating judgments. This is a big waste of money. Readmission within 30 days (or 6 months) of discharge is not a marker of quality care.

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.