Disease focus on reducing readmissions questioned

Should hospitals focus on the specific diseases that lead to the most readmissions, or should they look at internal issues that may be driving their overall readmission rates higher? It's a crucial question as hospital leaders search for ways to improve outcomes and avoid rising Medicare penalties for high readmission rates.

A new study suggests a disease-based focus on heart failure readmissions—one of the biggest drivers of high readmission rates—returns modest benefits at best.

The study, published by Circulation: Cardiovascular Quality and Outcomes, found less than a third of nearly 600 hospitals enrolled in two quality improvement programs had adopted most of the six simple steps that could lower heart failure readmission rates. The six strategies, identified through an online survey of the hospitals, ranged from requiring nurses to supervise medication plans to developing systems to forward discharge information to the patient's primary-care doctor. Only 7% of the hospitals in the survey had adopted all six measures.

But even if those steps were universally adopted, it would lower heart failure readmissions by just 2% and would save the hospitals in the survey about $100 million, the study found. Dr. Clyde Yancy, chief of the cardiology division at Northwestern University Feinberg School of Medicine in Chicago, told MedPage Today that he is "concerned that hospitals will immediately launch resources towards one or more of these meager six steps, with at best the hope for a modest impact. The larger message of a dysfunctional system cannot be ignored."

Hospitals should instead heed the advice of a Medicare physician advisory committee, which recommends eliminating “the current disease-specific model and focus(ing) on all readmissions. Hospitals could then use more resources on process issues and fewer futile efforts on already overburdened heart failure patients," Yancy said.

Follow Merrill Goozner on Twitter: @MHgoozner