High Readmission Rates May Not Mean Worse Hospital Care
Medicare plans to use data on returning patients as quality measure, but study questions validity
WEDNESDAY, July 14, 2010 (HealthDay News) -- When patients are readmitted within 30 days of a hospital stay, it is generally considered a sign of poor quality care and wasteful spending on the hospital's part.
But in a new analysis involving heart failure patients, Cleveland Clinic researchers challenge that conventional wisdom. Their calculations suggest that being readmitted to the hospital after an inpatient stay for heart failure may not be such a bad thing, after all.
Keeping more patients alive for a month in the first place means there are more patients eligible for readmission, they reason. They also suspect that assuring appropriate care for these patients, including any necessary procedures or surgery, may necessitate readmission to the hospital -- which would drive up readmission rates.
"I think that the message to patients and the general public is that they should be wary of seemingly simple measures of quality of care," said Dr. Eiran Z. Gorodeski, a researcher and associate staff member in cardiovascular medicine at the Cleveland Clinic. "One simple measure is not enough."
The analysis is described in a letter signed by Gorodeski and his Cleveland Clinic colleagues Drs. Randall C. Starling and Eugene H. Blackstone. The letter appears in the July 15 issue of the New England Journal of Medicine.
Policymakers are zeroing in on hospital readmission rates as part of an ongoing quest to improve health-care quality and reduce costs.
The federal health reform law enacted in March includes a provision requiring the U.S. Secretary of Health and Human Services to track readmission rates for certain high-cost conditions, including heart failure. Beginning Oct. 1, 2012, Medicare payments to hospitals with high readmission rates will be reduced.
The government began posting those readmission rates on the Hospital Compare website last week (www.hospitalcompare.hhs.gov)
The Centers for Medicare & Medicaid Services created Hospital Compare in partnership with the Hospital Quality Alliance to provide consumer-friendly information on hospital quality, patient experiences and other metrics. The new information shows how often Medicare patients with heart failure or another condition return to the same hospital or a different hospital within 30 days of their initial stay.
Nationally, the 30-day readmission rate for heart failure is 24.7 percent, according to Hospital Compare. The Cleveland Clinic's rate, at 28 percent, is worse than the national rate.
The same database shows that Cleveland Clinic's 30-day death rate for Medicare patients with heart failure, at 8.8 percent, is better than the national rate of 11.2 percent.
Researchers thought that was curious and wondered whether there might be some relationship between readmissions and mortality.
In an analysis of Hospital Compare data for 3,857 hospitals, they found that a higher occurrence of readmissions after the initial hospitalization for heart failure was associated with a lower, risk-adjusted 30-day death rate.
The authors conclude that this relationship between readmission and death rates needs to be investigated further.
Denise Love, executive director of the National Association of Health Data Organizations in Salt Lake City, agreed with the Cleveland Clinic team on that point.
"This needs to be investigated further and we need to improve it," Love said. But the government shouldn't stop reporting readmissions, she added. "It's something we need to look at because it's costing a lot of money, and it's causing a lot of patient burden," she said.
And as with any quality-of-care metric, "If you don't measure it, you're not going to improve it," she said.
Go to Hospital Compare to check your local hospitals' readmission rates.