The Centers for Medicare & Medicaid Services (CMS) announced last Thursday that it has added readmission rates for more than 4,000 hospitals across the U.S to its Hospital Compare website. With proper care, most people should not have to go back to the hospital shortly after release. This is a key indicator of quality and varies a lot between hospitals.
Research has shown that hospital readmissions are reducing the quality of health care while increasing hospital costs. Hospital Compare data show that for patients admitted to a hospital for heart attack treatment, 19.9 percent of them will return to the hospital within 30 days, 24.5 percent of patients admitted for heart failure will return to the hospital within 30 days, and 18.2 percent of patients admitted for pneumonia will return to the hospital within 30 days.
Many readmissions are the result of infections acquired in the hospital, a medical error, or other types of inadequate care. Health care leaders are looking closer at readmissions data to address health care quality and hospital pay as part of health reform. “It’s possible that readmissions are a substantial revenue stream for some hospitals,” said Dr. Mark Williams of Northwestern University, as reported by Triage.
While hospitals get paid even if the readmission could have been prevented by better care, readmissions are a burden on the health system as a whole. According to one 2007 analysis,
one of five Medicare hospital patients returns to the hospital within 30 days — at a cost to Medicare of $12 billion to $15 billion a year — and by 90 days the rate rises to one of three[.]Within a year, two out of three are back in the hospital — or dead.
Why should low performing hospitals be compensated the same as those who perform average or better? Denying payment for readmissions will promote more attention and care to this problem.
In the future, Medicare may stop paying for preventable readmissions. According to a recent Washington Post article, one health care reform proposal would have Medicare penalize hospitals with high readmissions rates for eight common chronic diseases. According to Doctor Pundit, “the examination of Medicare claims data based upon hospital admission rates is extremely important in this new era of under-the-microscope scrutiny by the Obama administration as a cost-containment mechanism.”
Our health care system should not be run like a fast food company where the more repeat visitors the better. We should be not rewarding hospitals for poor-quality-related readmissions. Hospitals should commit to improving quality and safety from the get-go, and be required to provide data to show how they are making progress.
We think the CMS addition of readmission rates is a good outcome measure for patients and policy makers alike. It is our goal that hospital infection rates will be another feature on the Hospital Compare site in the near future. Making all hospital infection rates public would help stop preventable readmissions and death, and allow us to save about $40 billion a year.
If you are interested in seeing how well your hospital, state and the nation as a whole are performing on surgical infection prevention practices, take a look at our Cutting Surgical Infections website. Based on our analysis, too many patients aren’t getting the right care needed to keep them safe.