Medicare readmission rate falls, but cause unclear, study says

Thu Jun 20 18:26:17 PDT 2013

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May 30, 2013

Medicare readmission rate falls, but cause unclear, study says

Modern Healthcare

By Joe Carlson

A new study finds that U.S. hospitals recorded about 70,000 fewer cases than
expected of Medicare patients being readmitted for inpatient care last year.

That finding is likely to hearten policymakers and health system leaders who
have pushed for financial incentives and procedures to improve
post-discharge care and coordination as a way to avoid readmissions. But the
study does not definitively show the decline in readmission rates was
directly caused by those payment and quality reforms.

Some observers are reacting cautiously to the findings, saying another
possible explanation for the statistical drop is that hospital officials are
skewing the statistics through creative application of the term "hospital
inpatient."

"It's kind of exciting to start to see the results tabulated on what
direction we're headed," said Matthew Press, an assistant professor of
public health and medicine at Weill Cornell Medical College in New York.
"But closer monitoring and analysis needs to happen to figure out how and
why these readmissions were averted."

The results were published Wednesday (PDF) in the online academic journal
Medicare & Medicaid Research Review. Study authors examined six years of
national data. Between 2007 and 2011, they documented a "remarkably stable"
trend that 19% of all Medicare patients returned to the hospital for further
treatment within 30 days after being discharged as an inpatient.

But in 2012, the national Medicare readmission rate dipped to 18.4%. That
relatively small percentage drop translated into more than 70,000 patients. 

The study found wide variation among regions in changes in readmission
rates. But the authors wrote that comparing differences in the data was
difficult because the data were not adjusted for differences in local
disease profiles and demographic factors. Still, larger hospitals in all
regions of the country tended to have higher rates of readmissions. 

The dip in readmission rates in 2012 coincided with Medicare's move to begin
cutting payments to hospitals with high readmission rates. That also was the
year when the concept of accountable care organizations-which more closely
coordinate inpatient and outpatient care and are paid based on
outcomes-began to grow. Hospitals also have been reporting readmissions in
to the Hospital Compare program, and working with the Partnership for
Patients program to reduce the readmission rate.

In February, CMS Medicare director Jonathan Blum told a congressional
committee that a 17.8% readmission rate recorded in the fourth quarter of
2012 "is an early sign that our payment and delivery reforms are having an
impact."

This week's study said Blum's assessment was one possible interpretation of
the data.

Ashish Jha, a professor of health policy at Harvard School of Public Health,
said the trend noted by Blum took place in the context of rising use of
"observation status" by hospitals, which could have affected the readmission
rate as well.

Readmissions data count only instances in which a person is admitted for
Medicare Part A hospitalization services. However, researchers with the CMS
and other organizations have noted that many hospitalized Medicare
beneficiaries are technically classified as outpatients under observation,
which is reimbursed under Medicare Part B for physician services. Patients
originally seen under observation status would not be counted as
readmissions if they later were hospitalized.

"The question to me is, have we really done a good job of preventing
readmissions, or have we just reassigned people who would have been
readmitted to a different status?" Jha said. "The jury is still out."

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

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