High Hospital Readmission Rates May Be Misleading

A new study suggests that the standard method used to calculate readmission rates is a misleading indicator of hospital quality.

Researchers at Loyola University Medical Center (LUMC; Proviso, IL, USA) examined the records of 5,780 spine surgery patients treated at the University of California San Francisco Medical Center (USA) between October 2007 and June 2011. Of these, 281 patients (4.9%) were readmitted within 30 days of the previous discharge date. The researchers performed an independent chart review to determine clinically relevant reasons for readmission, and extracted hospital administrative data to calculate direct costs. The researchers then evaluated possible predictors of readmission and the difference in direct cost between readmission and nonreadmission cases.

The results showed that the main reasons for readmission were infection (39.8%), nonoperative management (13.4%), and planned staged surgery (12.4%). Based on the manual chart review, 69 cases (25% of the 281 total readmissions) should be excluded, because 39 cases (13.9%) were planned staged procedures; 16 cases (5.7%) were unrelated to spine surgery; and 14 surgical cases (5.0%) were cancelled or rescheduled at index admission due to unpredictable reasons. When these 69 cases are excluded, the direct cost of readmission was reduced by 29%, representing a cost variance in excess of USD 3 million. The study was published in the February 2013 issue of Journal of Neurosurgery.

“Benchmarking algorithms for defining hospitals' readmission rates must take into account planned staged surgery and eliminate unrelated reasons for readmission,” concluded lead author neurosurgeon Beejal Amin, MD, and colleagues. “When this is implemented in the calculation method, the readmission rate will be more accurate.”

“Current algorithms overestimate clinically relevant readmission rates and cost. This overestimated rate may then be used by payers (that is, Medicare) to deny payment for clinically unavoidable readmissions,” added Dr. Amin. “Developing more sophisticated algorithms with spine surgeons' input will increase the reporting accuracy.”

Medicare (Baltimore, MD, USA) is trying to improve patient care by penalizing hospitals with poor outcomes. One key outcome measure is the readmission rate; one possible result is that Medicare may begin to withhold reimbursements to hospitals with excessively high readmission rates.

Related Links:
Loyola University Medical Center
University of California San Francisco Medical Center
Medicare