Study: Readmissions sometimes improve patient health

Accreditation Insider, September 6, 2016

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Are readmissions always bad? A new study by John Hopkins Medicine published in The Journal of Hospital Medicine says the answer is not as clear cut as once believed. Researchers looked at three years and 4,500 acute-care facilities worth of readmission and mortality data, finding that hospitals with high readmission rates tended to have lower mortality rates as well.

The study focused on the six conditions that CMS penalizes hospitals for in its readmissions reduction program: heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease (COPD), and coronary artery bypass. In particular, high readmission rates seemed to correlate with better mortality rates for COPD, heart failure, and stroke.

"But using readmission rates as a measure of hospital quality is inherently problematic," study author Daniel J. Brotman, MD, said in a press release. "High readmission rates could stem from the legitimate need to care for chronically ill patients in high-intensity settings." 

This especially applies to cases of medically fragile patients who may need that follow up care to stay alive, he said. Readmission rates are currently used in CMS’s hospital star ratings system and the agency financially penalizes hospitals that have high readmission rates.

Brotman said it’s "particularly problematic" that the star rating system applies equal weight to readmissions and mortality, saying that it unfairly skews the data against hospitals. While some readmissions are the result of preventable issues such as bad handoffs, he added, there are times when readmission results from serious disease and patient frailty.

"It's possible that global efforts to keep patients out of the hospital might, in some instances, place patients at risk by delaying necessary acute care," said Brotman.

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