A new study finds that U.S. hospitals recorded about 70,000 fewer cases than expected of Medicare patients being readmitted for inpatient care last year.
That finding is likely to hearten policymakers and health system leaders who have pushed for financial incentives and procedures to improve post-discharge care and coordination as a way to avoid readmissions
. But the study does not definitively show the decline in readmission rates was directly caused by those payment and quality reforms.
Some observers are reacting cautiously to the findings, saying another possible explanation for the statistical drop is that hospital officials are skewing the statistics through creative application of the term “hospital inpatient.”
“It's kind of exciting to start to see the results tabulated on what direction we're headed,” said Matthew Press, an assistant professor of public health and medicine at Weill Cornell Medical College in New York. “But closer monitoring and analysis needs to happen to figure out how and why these readmissions were averted.”
The results were published Wednesday (PDF)
in the online academic journal Medicare & Medicaid Research Review. Study authors examined six years of national data. Between 2007 and 2011, they documented a “remarkably stable” trend that 19% of all Medicare patients returned to the hospital for further treatment within 30 days after being discharged as an inpatient.
But in 2012, the national Medicare
readmission rate dipped to 18.4%. That relatively small percentage drop translated into more than 70,000 patients.
The study found wide variation among regions in changes in readmission rates. But the authors wrote that comparing differences in the data was difficult because the data were not adjusted for differences in local disease profiles and demographic factors. Still, larger hospitals in all regions of the country tended to have higher rates of readmissions.
The dip in readmission rates in 2012 coincided with Medicare's move to begin cutting payments to hospitals with high readmission rates. That also was the year when the concept of accountable care organizations—which more closely coordinate inpatient and outpatient care and are paid based on outcomes—began to grow. Hospitals also have been reporting readmissions in to the Hospital Compare program, and working with the Partnership for Patients program to reduce the readmission rate.
In February, CMS Medicare director Jonathan Blum told a congressional committee
that a 17.8% readmission rate recorded in the fourth quarter of 2012 “is an early sign that our payment and delivery reforms are having an impact.”
This week's study said Blum's assessment was one possible interpretation of the data.
Ashish Jha, a professor of health policy at Harvard School of Public Health, said the trend noted by Blum took place in the context of rising use of “observation status” by hospitals, which could have affected the readmission rate as well.
Readmissions data count only instances in which a person is admitted for Medicare Part A hospitalization services. However, researchers with the CMS and other organizations have noted that many hospitalized Medicare beneficiaries are technically classified as outpatients under observation, which is reimbursed under Medicare Part B for physician services. Patients originally seen under observation status would not be counted as readmissions if they later were hospitalized.
“The question to me is, have we really done a good job of preventing readmissions, or have we just reassigned people who would have been readmitted to a different status?” Jha said. “The jury is still out.”Follow Joe Carlson on Twitter: @MHJCarlson