Hospitals may be unfairly punished for high readmission rates

(Medical Xpress)—When hospital patients have to be readmitted soon after discharge, hospitals look bad.

A high readmission rate also can result in reduced Medicare reimbursements. But a study of patients has found that the standard method used to calculate is a misleading indicator of hospital quality. Loyola University Medical Center Beejal Amin, MD, and colleagues found that 25 percent of the readmissions of spine surgery patients were not due to true quality-of-care issues.

Results are reported in a featured article in the February, 2013 issue of the .

"We have identified potential pitfalls in the current calculation of readmission rates," Amin said. "We are working on modifying the algorithm to make it more clinically relevant."

Medicare is trying to improve patient care by penalizing hospitals with poor outcomes. One key outcomes measure is the readmissions rate. Medicare may begin to withhold reimbursements to hospitals with excessively high readmission rates.

In spine surgery, a high readmission rate can indeed reflect poorly on a hospital's quality of care if the readmissions are due to reasons such as infections, surgical complications, and failures of surgical hardware, Amin said.

But some types of readmissions are not a true indication of quality of care, Amin said. Such cases include:

  • Planned readmission for a staged procedure. For example, a procedure to straighten a curved spine in a patient requires two surgeries performed in different stages.
  • Readmission unrelated to spine surgery. Occasionally, patients who undergo spine surgery will be readmitted within 30 days for surgery for an unrelated condition, such as a hip replacement.
  • Operation cancelled or rescheduled for unpreventable reasons. For example, a patient is admitted to the hospital but the spinal surgery is postponed due to an irregular heart rate. The patient is readmitted a couple weeks later for elective surgery, after the heart rhythm is controlled.

Amin and colleagues examined the records of 5,780 spine surgery patients treated at the University of California San Francisco Medical Center between October, 2007 and June, 2011. (Before joining Loyola, Amin did a clinical fellowship in complex spine surgery at UCSF under Dr. Praveen Mummaneni. Currently, Amin is an assistant professor in the Department of Neurological Surgery at Loyola University Chicago Stritch School of Medicine. His clinical expertise is in minimally invasive and complex spine surgery.)

The study found that, under the standard readmission formula, 281 patients were readmitted within 30 days of discharge. But 69 of these readmissions (25 percent) should not have been counted against the hospital. These included 39 cases that were planned readmissions for staged procedures, 16 cases that were unrelated to spine surgery and 14 cases that were cancelled or rescheduled due to unpreventable reasons.

"From the clinician's point of view, this 25 percent of readmission cases was appropriate and unavoidable," the authors wrote. "Efforts to curtail such readmissions would be unnecessary and potentially use resources that could be directed elsewhere."

Amin and colleagues concluded that their findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets.

"Current algorithms overestimate clinically relevant readmission rates and cost," Amin and colleagues wrote. "This overestimated rate may then be used by payers (that is, Medicare) to deny payment for clinically unavoidable readmissions. Developing more sophisticated algorithms with spine surgeons' input will increase the reporting accuracy. Surgeons can play a vital role to help improve benchmarking and improve the value of health care provided."

add to favorites email to friend print save as pdf

Related Stories

Recommended for you

Doctor behind 'free radical' aging theory dies

18 hours ago

Dr. Denham Harman, a renowned scientist who developed the most widely accepted theory on aging that's now used to study cancer, Alzheimer's disease and other illnesses, has died in Nebraska at age 98.

Mexican boy who had massive tumor recovering

Nov 25, 2014

An 11-year-old Mexican boy who had pieces of a massive tumor removed and who drew international attention after U.S. officials helped him get treatment in the southwestern U.S. state of New Mexico is still recovering after ...

New medical device to make the mines safer

Nov 21, 2014

Dehydration can be a serious health issue for Australia's mining industry, but a new product to be developed with input from Flinders University's Medical Device Partnering Program (MDPP) is set to more effectively ...

US family gets $6.75 million in Botox case

Nov 20, 2014

A New York couple who said Botox treatment of their son's cerebral palsy left him with life-threatening complications and sued its manufacturer won a $6.75 million verdict from a federal jury on Thursday.

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.