Texas Tech University Health Sciences Center
Complexities of Measuring Hospital Readmissions

Complexities of Measuring Hospital Readmissions

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.

Have a great week—summer is drawing to a close.