At Johns Hopkins hospital, doctors and executives know they may face penalties in the coming years for surgical readmissions. Payers are instituting more value-based and accountable care initiatives to hold providers responsible for keeping patients healthy and reducing costs.

To better understand the issue, Johns Hopkins researchers embarked on a project that examined how readmission rates varied at their hospital in eight surgical subspecialties. They found that 82.8 percent of the variation in readmissions was due to patient-related factors, 14.5 percent was due to the type of surgical subspecialty and only 2.8 percent was due to surgeon-level factors.

Factors associated with greater odds for a 30-day readmission included patient comorbidity, race/ethnicity, insurance status, a longer length of hospital stay and developing postoperative complications.

“The use of readmission as a quality parameter is based on the underlying premise that it accurately represents the ability of a hospital to provide care and appropriately discharge patients,” the researchers wrote in the study, which was published online in JAMA Surgery on Aug. 5. “Similar to findings of this study, recent evidence has demonstrated that readmission may in fact be largely a function of nonmodifiable patient factors, such as lower socioeconomic conditions and poor access to care.”

Hospitals are at a disadvantage if they serve a disproportionate amount of people with comorbid conditions, are uninsured or are African Americans, according to Timothy M. Pawlik, MD, MPH, PhD, a study author and chief in Johns Hopkins’ division of surgical oncology. Those factors are largely out of a hospital's control.

Still, Pawlik offered a few ways that surgeons and hospitals could possibly reduce their readmission rates. He suggested better educating patients on medication adherence and other topics, improving care coordination with discharge teams and having nurse practitioners or physician assistants follow up with patients at high-risk for readmissions after they are discharged.

If the Centers for Medicare & Medicaid Services (CMS) expands its hospital readmission reductions program to surgical subspecialties, these results could help CMS ignore a one-size-fits-all approach and adopt more lenient rules based on the subspecialty and patient case mix.

“Papers like this help understand the problem because if you don’t understand the problem, if you don’t understand that that there is variation or understand where the variation is coming from, then it’s hard to design solutions,” Pawlik told Cardiovascular Business. “I think this is an important first step of trying to understand what the problem is, what the significance of the problem is, how many patients are actually getting readmitted across all these different subspecialties and understanding where the variation’s coming from.”

-Tim Casey
Executive Editor - CardiovascularBusiness.com