AHA: Gov't should focus on avoidable readmissions only
Public policies should focus on readmissions that may be avoidable—those that are unplanned and related to the initial admission, such as a surgical site infection, according to a report from the American Hospital Association (AHA).
The AHA TrendWatch report examined recent research on hospital readmissions, including links between readmissions and quality of care, and the circumstances that may drive readmissions.
According to the Medicare Payment Advisory Commission, nearly one-fifth of all Medicare beneficiaries discharged from a hospital return within 30 days, AHA cited. The organization, in consultation with clinicians, developed a framework to help policymakers and providers consider different types of readmissions, including four distinct types:
While reducing avoidable hospital readmissions will improve healthcare quality and lower spending, not all readmissions can or should be avoided, the report noted. Some of the readmissions are planned, some are unplanned and others are unrelated to the initial reason the patient came to the hospital.
“Planned readmissions and those unrelated to the initial admission either should not or cannot be prevented by hospitals,” the organization continued. “Hospitals cannot influence the occurrence of unplanned, unrelated readmissions because they are not predictable or preventable.”
The AHA identified in the report that it has noticed a technical error in the Patient Protection and Affordable Care Act (PPACA) language that leads to an overstatement of the amount of money hospitals must pay back to the Medicare program. “The formula was intended to use a hospital’s number of expected readmissions for each condition as the basis for the calculation in order to calculate the payments associated with excess readmissions,” the organization stated. “Instead, the formula in the statute uses a hospital’s total number of admissions for the conditions. This error, if left unresolved, will inappropriately inflate hospitals’ payment reductions."
AHA stated it believes the technical error in the PPACA should be clarified in order to recoup an appropriate amount from hospitals with excess readmissions.
While the PPACA aims to improve quality and save costs by reducing readmissions, recent evidence suggests that it is difficult to draw conclusions about quality of patient care using data only on readmissions, according to the report. “Most confounding is the evidence of an inverse relationship between readmissions and mortality,” the report added.
“More research is needed on the drivers of readmissions,” concluded the report. “Such insight will be integral to developing risk adjusters that appropriately account for patient characteristics, including socioeconomic factors, and hospitals’ particular circumstances and patient mix in determining financial penalties for readmissions.”
AHA advised policymakers seeking statutory or regulatory levers to reduce readmissions should carefully weigh the potential for unintended adverse consequences. “Payment penalties intended to shrink readmission rates could exacerbate inequities and leave hospitals with fewer resources to make needed investments in improving patient care. Further, misaligned policies could direct hospitals to reduce readmissions that are appropriate for safe patient care and may actually save lives,” the AHA noted.
The AHA TrendWatch report examined recent research on hospital readmissions, including links between readmissions and quality of care, and the circumstances that may drive readmissions.
According to the Medicare Payment Advisory Commission, nearly one-fifth of all Medicare beneficiaries discharged from a hospital return within 30 days, AHA cited. The organization, in consultation with clinicians, developed a framework to help policymakers and providers consider different types of readmissions, including four distinct types:
- A planned readmission related to the initial admission, such as a series of chemotherapy treatments or reconstructive surgery following removal of a body part.
- A planned readmission unrelated to the initial admission, such as readmission for removal of a lung tumor discovered during an admission for a heart attack.
- An unplanned readmission unrelated to the initial admission, such as readmission for a fracture sustained in a car accident following an initial stay for an appendectomy.
- An unplanned readmission related to the initial admission, such as readmission for a surgical site infection or adverse reaction to a medication.
While reducing avoidable hospital readmissions will improve healthcare quality and lower spending, not all readmissions can or should be avoided, the report noted. Some of the readmissions are planned, some are unplanned and others are unrelated to the initial reason the patient came to the hospital.
“Planned readmissions and those unrelated to the initial admission either should not or cannot be prevented by hospitals,” the organization continued. “Hospitals cannot influence the occurrence of unplanned, unrelated readmissions because they are not predictable or preventable.”
The AHA identified in the report that it has noticed a technical error in the Patient Protection and Affordable Care Act (PPACA) language that leads to an overstatement of the amount of money hospitals must pay back to the Medicare program. “The formula was intended to use a hospital’s number of expected readmissions for each condition as the basis for the calculation in order to calculate the payments associated with excess readmissions,” the organization stated. “Instead, the formula in the statute uses a hospital’s total number of admissions for the conditions. This error, if left unresolved, will inappropriately inflate hospitals’ payment reductions."
AHA stated it believes the technical error in the PPACA should be clarified in order to recoup an appropriate amount from hospitals with excess readmissions.
While the PPACA aims to improve quality and save costs by reducing readmissions, recent evidence suggests that it is difficult to draw conclusions about quality of patient care using data only on readmissions, according to the report. “Most confounding is the evidence of an inverse relationship between readmissions and mortality,” the report added.
“More research is needed on the drivers of readmissions,” concluded the report. “Such insight will be integral to developing risk adjusters that appropriately account for patient characteristics, including socioeconomic factors, and hospitals’ particular circumstances and patient mix in determining financial penalties for readmissions.”
AHA advised policymakers seeking statutory or regulatory levers to reduce readmissions should carefully weigh the potential for unintended adverse consequences. “Payment penalties intended to shrink readmission rates could exacerbate inequities and leave hospitals with fewer resources to make needed investments in improving patient care. Further, misaligned policies could direct hospitals to reduce readmissions that are appropriate for safe patient care and may actually save lives,” the AHA noted.