Reading into Readmissions

The newly added readmission data to the CMS’ Hospital Compare Web site might help hospitals tracking that information, but the consumers targeted by the site still might not find much use for the data, some say.

And while hospitals now have even more information to comb through when scrutinizing their own performance, they could find more benefits if that information extended beyond only one measure of rehospitalization, according to one researcher.

The federal agency this month began posting hospitals’ readmission rates as an outcome measure to the site, which can be used by the public to search for information on how providers are faring in delivering healthcare. While consumers so far have been slow to turn to comparison Web sites to help them make choices about providers, Hospital Compare data are used by hospitals themselves as they conduct their own research and see how it matches up to the federal information.

The CMS posted the national 30-day readmission averages for three conditions: heart attack, heart failure and pneumonia. The agency scores hospitals against those rates, with hospitals falling into one of three categories: “worse than,” “better than” or “no different” from the national average. In addition to hospitals being able to see their own readmission scores, now they can track when a patient leaves their facility and is readmitted elsewhere, according to the CMS.

But the information on Hospital Compare still gives little guidance to consumers who want to use publicly reported data to make decisions about their hospitals, said Leah Binder, CEO of the Leapfrog Group, which includes readmissions scores in its annual hospital survey. About 97% of hospitals fell into the “no different” than the national average category for heart attacks, and only 2% were considered “worse” than average, according to the CMS data. If that’s true, those 2% “must be extreme cases,” Binder said. But consumers still don’t know how well the average hospitals are performing. The CMS data are a “good first step,” she said. “But it doesn’t tell you very much else.”

The Hospital Compare information is a starting point, but hospitals can go further, said Mary Naylor, a registered nurse who is director of the NewCourtland Center for Transitions and Health at the University of Pennsylvania School of Nursing. She is a researcher who has helped design interventions for improving the care process and reducing admissions. That research has shown that looking 30 days out “should not be the end date,” she said. “We now have evidence to really interrupt the cycle of readmissions.”

Nevertheless, the move was welcomed by some experts. Having the readmission rates available on the site adds a welcomed dimension that had been missing, said Brian Jack, a physician who is associate professor of the department of family medicine at Boston Medical Center. The Hospital Compare information will help providers “drill down” into their own information and see where the problems exist when discharging patients, he said.

The data on the site can serve as a benchmark as hospitals do their own research, said Mark Williams, professor and chief of the division of hospital medicine at Northwestern University’s Feinberg School of Medicine. “There’s new data there that we would respond to,” he said. “I think prior to this, everyone was operating in the dark.”

Both Jack and Williams also are researchers involved in developing initiatives that aim to reduce readmissions. Programs like that become more important to hospitals striving to lower costs and improve care, Jack said. There is “profound” discontinuity of care when patients leave the hospital. And aligning financial incentives with those transitions will improve the current operating model, which typically requires hospitals to admit patients, discharge them quickly, then readmit them, Jack added. “That’s a perverse incentive.”

Legislators and quality advocates have turned the spotlight on readmissions this year as a way to measure healthcare outcomes. In addition to measuring outcomes, federal regulators are considering how to tie readmissions to reimbursement (June 29, p. 12).

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