Remember to read the fine print, or in the case of some studies, the appendices.
Thomas C. Tsai, MD, of the Harvard School of Public Health in Boston, and colleagues published a paper this week in the New England Journal of Medicine that found the median risk-adjusted composite 30-day readmission rate for six surgical procedures was 13.1 percent. The study explored the relationship between readmission rates and surgical care. As part of the research, the Tsai team looked at three quality measures: the Hospital Quality Alliance surgical care score, volume and mortality.
The researchers chose the six procedures—CABG, pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm (EVAR), open repair of abdominal aortic aneurysm (AAA), colectomy and hip replacement—because they were common and costly. They pointed out that CABG and AAA are on the docket for Medicare penalties under the Readmissions Reduction Program by 2015. “[A]n understanding of patterns of readmission after these procedures will provide specific insight into the implications of federal policy efforts,” they wrote.
The composite data may provide some guidance for cardiovascular specialists and hospitals performing CABG, AAA and EVAR, but results from each individual procedure likely will be of more interest. Those results appeared in appendices.
Of the three procedures, only EVAR placed below the composite rate. The unadjusted rate for CABG was 17.4 percent; AAA 13.4 percent and EVAR 11 percent.
A table that listed procedure-specific risk-adjusted 30-day readmission rates is a gold mine, especially the data on volume and mortality that stratified rates by quartile. Under CABG, for instance, the highest volume quartile had the lowest readmission rate, at 19.2 percent vs. 17.2 percent for the lowest quartile.
The researchers wrote that evidence of a relationship between readmission rates and surgical quality measures “should offer some reassurance to policymakers who wish to use surgical-readmission rates to grade and pay hospitals.” Their work also highlights for physicians and hospitals the window of opportunity to identify where quality efforts may be lacking and improve them before penalties come into play.
Cardiovascular Business, editor