Hospitals may breathe easier after a study published online Feb. 13 in the Journal of the American Medical Association found no strong relationships between mortality and 30-day readmissions rates for acute MI, heart failure and pneumonia.
In October of 2012, the Centers for Medicare & Medicaid Services initiated a program that penalizes hospitals with worse-than-expected 30-day readmission rates for the three conditions. This year, the penalty is set at 1 percent in withheld reimbursement and will rise to 2 percent and 3 percent in 2014 and 2015. The stakes may not seem high this year but the increases could be painful, particularly for hospitals that already are pinched.
The readmissions penalty has raised concerns that it might unfairly punish hospitals that succeed in keeping sicker patients alive to discharge as well as unintentionally reward hospitals that do not. Critics fear that hospitals with low mortality rates face the risk of higher readmissions while hospitals with higher mortality rates do not—since patients who might be most at risk never survived to discharge.
The analysis examined the relationship between risk-adjusted mortality and readmissions rates at the hospital level. It found no evidence of a strong relationship between mortality and readmissions, although there was a whisper of a relationship in the heart failure measures. The percentage of hospitals ranked as top performers for both mortality and readmissions ranged from 8.5 percent for acute MI to 5.4 percent for heart failure; 6.7 percent of hospitals were bottom performers in mortality and readmissions for acute MI and 5.3 percent for heart failure.
Do these measures reflect overall quality? Are the measures a subset of outcomes from hospitals that could be described simply as good and bad?
The findings held up in a subgroup analysis that included safety-net status. But a research letter published recently in the same journal found that safety-net hospitals were at the highest risk of being penalized.
The current study may not settle the issue, particularly for hospitals that fall in the poor performance category. But for top performers, the findings probably provide relief.
Candace Stuart
Cardiovascular Business, editor