Medicare’s condition-specific readmission measures are poor reflectors of hospital quality

1. High variability was observed within hospital risk-standardized excess readmission ratios.

2. Ratios among Medicare reported medical condition group often overestimated the values for the Medicare unreported medical condition group.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Readmissions to hospitals have become a priority for policy makers, as they are a high source of costs and occur frequently. It has become increasingly important to decrease readmissions for certain conditions, including heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Furthermore, Medicare readmission rates for these specific conditions are used to draw broader conclusions in terms of hospital global quality metrics. The objectives of this study were to evaluate whether hospital-level 30-day readmission measures for HF, AMI, and pneumonia among Medicare patients are representative of those for Medicare patients hospitalized for conditions that are not reported, as well as for non-Medicare patients that are hospitalized with the above conditions. Generally, it was observed that Medicare’s condition-specific readmission measures are poor reflectors of hospital quality. This study has several limitations. Of note, the groups used in the study differ slightly from those that are used by the Centers for Medicare and Medicaid Services to determine risk adjustment and other variables. Overall, the results of the study suggest that risk-standardized excess readmission ratios (ERRs) in hospitals are poor estimates of unreported conditions and other patient populations.

Click to read the study, published today in Annals of Internal Medicine

Relevant Reading: Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

In-Depth [retrospective cohort]: The authors of this study conducted a cross-sectional, population based study, utilizing hospitals in the Nationwide Readmissions Database in 2013 and 2014. The primary outcomes included the hospital-level 30-day all-cause risk standardized ERRs for three distinct patient groups: Medicare patients that were admitted for either HF, AMI, or pneumonia, Medicare patients admitted for other conditions, and non-Medicare patients admitted for HF, AMI, or pneumonia. The authors excluded patients younger than 65 from the Medicare groups as they determined these patients represented a statistically different population not included in the Centers for Medicare and Medicaid Services calculations. A total of 18 150 648 admissions were included in the study overall. The reported medical conditions ratios differed compared to the unreported ratios by greater than 0.1% for 28% of the hospitals. Furthermore, the differences in the ratios between Medicare and non-Medicare patients with HF, AMI, and pneumonia differed by more than 0.1 for 46% of the hospitals. Specifically, the differences ranged from -0.52 to 0.39.

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