Hospital readmission rates reported by CMS for patients with certain conditions may not accurately reflect the actual quality of care delivered at hospitals, according to a study published in the Annals of Internal Medicine.
CMS' excess readmission ratios — which comprise data on readmissions for heart failure, heart attack and pneumonia — are used to determine Medicare reimbursement. To determine whether these ratios accurately reflect the quality of care delivered to all hospital patients, researchers analyzed ERRs across three patient groups. Researchers used more than 2,100 hospital observations documented in a nationwide readmissions database from 2013-14 to compare the ERRs of Medicare beneficiaries admitted for heart failure, heart attack or pneumonia; patients covered by non-Medicare payers; and Medicare beneficiaries admitted for conditions not including heart failure, heart attack or pneumonia.
Analysis revealed 29 percent of hospitals currently penalized by CMS would no longer incur penalties if the agency included readmissions related to conditions other than heart failure, heart attack or pneumonia. Researchers also found 40 percent of hospitals penalized by CMS would not face penalties if performance assessment was based on readmission rates for non-Medicare patients hospitalized for heart failure, pneumonia or heart attack.
"Significant attention has been given to hospitals' overall performance as determined by the public reporting of a small number of specific conditions and patient populations," said Robert Yeh, MD, associate professor of medicine at Harvard Medical School in Boston and one of the study's authors. "Our results suggest that although performance on readmission may reflect broader institutional characteristics, the concordance of each hospital's performance across different conditions varies substantially. It goes to show that Medicare metrics alone may not be the final word on hospital quality for readmissions."
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