Criticism of the use of hospital readmissions as a measure of quality tends to ignore real improvements hospitals are making in patient care, according to a post on the Health Affairs blog.
CMS recently announced penalties for excessive 30-day readmissions under the Hospital Readmissions Reduction Program would increase from 1 percent to 2 percent of Medicare reimbursement for fiscal year 2014. This increase equates to a total of $227 million in fines for 2,225 hospitals, which is $53 million less than the fines imposed for the current fiscal year. The decrease suggests improvements have been made in readmission reduction, according to the blog post authors.
While many people have questioned the fairness of these penalties, the outcome — that more hospitals are focused on reducing readmissions — improves patient care by averting needless returns to the hospital and lowers costs, the authors state. They point to a February report by CMS that showed readmissions decreased from an average 19 percent in the past five years to 17.8 percent as of November 2012.
In addition, while one of the major complaints of the readmission measure is that it may unfairly penalize safety-net hospitals, this argument should not be used as an excuse for maintaining the status quo, according to the authors. Many hospitals serving a large population of low-income patients, such as New York Methodist Hospital in New York City and Temple University Health System in Philadelphia, have reduced readmissions, according to the blog post.
The authors recognize the difficulty of reducing readmissions, and the value of questioning the measure and reports of improvement. However, they argue that these questions should not obscure the measure's overall goals — to improve patient care and lower costs — and the proven possibility of improvement.
"We acknowledge that managing readmissions is a complex task, but thanks to the Medicare program, hospitals are taking an important leadership role that was previously unfilled," the authors wrote.
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