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Medicare’s readmission measures misrepresent hospital quality

Robert W. Yeh

Condition-specific readmission measures from Medicare may provide an incomplete and inaccurate depiction of hospital quality, according to research published in Annals of Internal Medicine.

“The federal government currently provides one of the most used hospital quality ranking systems,” Robert W. Yeh, MD, MSc, senior author of the study and director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center, told Healio Internal Medicine. “These rankings are not only used by the public, but also help determine financial penalties for low performing hospitals.”

“However, the rankings are based only on how hospitals fare with regard to the outcomes of Medicare-insured patients for a selected number of conditions,” he continued. “How these rankings might actually change if one examined the entire population of treated patients, including non-Medicare patients as well as patients hospitalized for unreported conditions, would help determine whether these rankings painted a complete or biased picture of a hospital’s quality of care.”

Yeh and colleagues conducted a cross-sectional study to determine if hospital 30-day readmission rates for publicly reported conditions, including heart failure, acute MI and pneumonia, among Medicare patients (Medicare reported group) represent the rates for non-Medicare patients hospitalized with these conditions (non-Medicare group) or Medicare patients hospitalized with unreported conditions (Medicare unreported group).

The researchers found that there was a wide variation in the within-hospital differences in all-cause risk-standardized excess readmission ratios (ERRs) between all groups. There was a more than 0.1 difference in ERRs for Medicare reported ratios in 29% of hospitals and for non-Medicare ratios in 46% of hospitals. These differences suggested that the total dollar amount of a hospital’s financial penalty changed by more than 10%, according to the researchers.

In hospitals with high readmission ratios, ERRs for the non-Medicare group were overestimated and ERRs for the Medicare unreported group were underestimated by the ERRs for the Medicare reported group.

“These findings are relevant to many different constituencies, not just clinicians,” Yeh said. “For patients who use these metrics to help evaluate hospitals and determine where they would like to see their care, they should be aware that in some cases, these report cards don’t tell the full story and may not be relevant to them depending on their demographic or their medical conditions. For policy makers, increased efforts should be made to better understand on the national level the care quality of not only Medicare-insured patients, but also other important populations.”

Determining how to better measure and improve quality of care for Medicaid patients is an important next step, according to Yeh.

“We and others have shown that preventable hospitalizations are particularly common in the Medicaid population, but we have fewer widely available metrics to help shine a light on how individual hospitals are doing in their care,” he said.

“The CMS rankings are important and incentivize improvements in health care,” he added. “But we should also keep in mind that they give only a limited window into the total quality of care at any given hospital.” – by Alaina Tedesco

Disclosure: Yeh reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.