Texas Tech Physicians works to prevent inappropriate readmissions with all of the
hospitals with which we are associated, especially UMC, where the majority of our
patients are hospitalized. Inappropriate readmission is a bit of a vague term. Basically,
as defined by the Centers for Medicare and Medicaid (CMS), it pertains to Medicare
patients returning to the hospital within a month of discharge. It is not utilized
in every diagnosis.
The data used to evaluate the hospitals is based on readmissions between July 2011
and June 2014 for patients originally hospitalized for one of five conditions: heart
attack, heart failure, pneumonia, chronic lung problems or elective hip or knee replacements.
The way CMS does this is they establish a target for each hospital. CMS is not saying
a hospital should have zero readmissions. Rather, they determine what they think is
the appropriate number of readmissions, based on the mix of patients and how the hospital
industry performed overall. If the number of readmissions is above that target, Medicare
fines the hospital.
So how is this going?
Medicare is fining the majority of the nation’s hospitals for having too many patients
readmitted within a month of discharge. In the fourth year of federal readmission
penalties, 2,592 hospitals will receive lower payments for every Medicare patient
who stays in the hospital, readmitted or not, starting in October. These reduced payments
are brought about by the Hospital Readmissions Reduction Program, which is part of
the Affordable Care Act that requires CMS to reduce payments to hospitals with excess
readmissions. It is a high price for a hospital to pay.
It is true that since the fines began, national readmission rates have dropped, but
roughly one of every five Medicare patients sent to the hospital ends up returning
within a month. Sometimes this is not even related to the first hospitalization, which
can seem a bit unfair. For example, in talking with one of our Texas Tech Physicians
surgeons he explained that one particular patient did very well in surgery and had
an unremarkable recovery (meaning a “good” recovery). However, the patient was readmitted
within 30 days for a urinary tract infection (UTI) that had nothing to do with the
surgery! Yet, the UTI admission counted against the surgeon and the hospital in the
official statistics.
We hope there are not too many examples like this. But, the case underscores the complexity
of it all. I favor trying to mitigate the number of readmissions, but my point is
nothing is simple when it comes to practicing medicine and measuring quality.
