The Obama administration and health policy experts have been touting last year's decline in Medicare 30-day hospital readmissions as evidence that delivery and payment reforms designed to prevent unnecessary repeat visits were starting to succeed.
But one reason the readmission numbers may be declining is that hospitals increasingly are handling patients on so-called outpatient observation status, which in many cases is indistinguishable from inpatient admission. Since observational-status patients aren't counted as admissions, they aren't counted as readmissions if those patients are hospitalized within 30 days. Similarly, if observational patients had been hospitalized within 30 days prior to the observational-status treatment, that treatment wouldn't be counted as a readmission.
The possible interaction of the higher rate of observation status cases and lower rates of readmissions within 30 days is prompting tough questions about whether policymakers and providers should rely so heavily on 30-day readmissions as a key barometer of hospital quality and cost performance.
“Fundamentally, 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?” said Dr. Ashish Jha, professor of public health policy at the Harvard School of Public Health in Boston.
The concern about the validity of Medicare's 30-day readmissions data comes just as the stakes for hospitals are rising. Last October, the CMS began docking hospitals' pay by up to 1% of total Medicare funding based on how many patients returned for care within 30 days for heart failure, heart attack and pneumonia, based on a program to cut preventable readmissions in the Patient Protection and Affordable Care Act.