High hospital readmissions not tied to spike in deaths, Johns Hopkins research shows
In fact, results show that patients treated at facilities that had more readmitted patients had a slightly better chance at survival.
Researchers have found that hospitals with the highest rates of readmission were actually more likely to show better mortality scores in patients treated for heart failure, COPD and stroke.
In fact, the a study by a group of Johns Hopkins physicians and researchers suggests there is a problematic relationship between the data on mortality and hospital readmissions used by the Centers for Medicare and Medicaid Services to score and reimburse hospitals.
Daniel J. Brotman, MD, and his colleagues examined three years of CMS' publicly available data from hospitals across the United States. They looked at nearly 4,500 acute care facilities' hospital-wide readmission rates and compared them with those facilities' mortality rates in six areas used by CMS: heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease and coronary artery bypass.
In each case, adjusted odds ratios showed that patients treated at facilities that had more readmitted patients had a slightly better chance at survival than patients who were cared for at hospitals with lower readmission rates.
In an effort to save money and to encourage more efficient care, CMS has begun limiting its reimbursement in cases in which patients are readmitted to the hospital within a month of discharge.
Brotman commended CMS on its efforts to reduce healthcare costs, but added in a statement that "using readmission rates as a measure of hospital quality is inherently problematic. High readmission rates could stem from the legitimate need to care for chronically ill patients in high-intensity settings," especially, he says, in cases of medically fragile patients who have been kept alive against the odds.
Brotman singled out CMS's Star Report as "particularly problematic." He said applying equal weight to readmissions and mortality -- as the Star Report does -- unfairly skews the data against hospitals. While admitting that high readmission rates could stem from complications or bad handoffs, Brotman said there are times when readmission results from serious disease and patient frailty.
[Also: Adult mortality rates in emergency departments plummet by 50 percent, Health Affairs study says]
"It's possible that global efforts to keep patients out of the hospital might, in some instances, place patients at risk by delaying necessary acute care," he said.
The CMS program, which mainly uses patient answers on Hospital Consumer Assessment of Healthcare Providers and Systems surveys to assign an overall star rating that it makes public on its Hospital Compare database, has come under scrutiny as of late. The federal agency has said it is studying how socioeconomics play into these scores. It also plans to roll out a more comprehensive overall star rating in the near future.
Earlier this year, The American Hospital Association commissioned Francis Vella, chair of the department of economics at Georgetown University, to review CMS' Overall Hospital Star Ratings methodology.
"The approach adopted does not consider anything apart from quality outcomes," he said in a letter to the AHA. "For example, it does not adjust for the nature of the patients or the different circumstances hospitals might encounter. I cannot see how one can ignore the implications of these factors on such measures such as mortality."
Twitter: @JELagasse
