Hospital readmissions among Medicare patients may be on the decline, but a recent Health Affairs Blog post calls into question whether the recent drop is due to advances in care and patient safety or a gaming of the system.
According to the blog post authors, David Himmelstein, MD, and Steffie Woolhandler, MD, hospitals are increasingly observing patients, or treating returning patients in the emergency department, as opposed to actually readmitting them.
"While relabeling helps hospitals meet CMS' quality standards (and avoid costly fines), it probably signals little real quality gain and often leaves patients worse off financially," wrote Drs. Himmelstein and Woolhandler.
The authors suggest hospitals started categorizing more stays as observations after Medicare stopped allowing brief hospital admissions to receive the entire Medicare payment. Additionally, more discharged patients are being treated in emergency departments — without being admitted — as well.
They go on to argue that while some hospitals have undoubtedly reduced readmissions by improving patient care and communication with outpatient providers, many hospitals are pressured by pay-for-performance initiatives to take short cuts and relabel patient stays.
Drs. Himmelstein and Woolhandler concluded by invoking the words of famous graffiti artist Banksy to describe a potential problem with pay-for-performance initiatives: "Become good at cheating and you never need to become good at anything else."
More articles on readmissions:
Reducing unnecessary hospital readmissions: Time to think inside the box
Survey reveals physicians have negative views of quality metrics, readmission penalties: 5 takeaways
10 states where most hospitals face Medicare readmission penalties