“Our findings suggest that hospitals may best achieve low rates of readmission by employing strategies that lower readmission risk globally rather than for specific diagnoses or time periods after hospitalization,” said Dr. Kumar Dharmarajan, a visiting scholar at the Center for Outcomes Research and Evaluation at Yale, and the study's lead author.
Researchers from the Yale University School of Medicine analyzed three years of Medicare data covering more than 600,000 30-day readmissions for heart failure, heart attack or pneumonia at more than 4,000 hospitals.
Those are the same conditions tracked by the federal government's Readmissions Reduction Program, a provision of the Patient Protection and Affordable Care Act that docks hospitals with high rates of readmissions on their Medicare payments. More than 2,200 hospitals will lose up to 2% of their base-operating DRG payments in the upcoming year, up from a 1% maximum penalty in 2013.
The results come as many initiatives targeting smaller subsets of readmissions are seeing lackluster results, the authors said.
Dr. Harlan Krumholz, professor of cardiology at Yale University of Medicine and another of the study's authors, said the study demonstrated the need to focus on the “patient as a whole rather than what caused them to be admitted.”
“And this study adds emphasis to the idea that patients are susceptible to a wide range of conditions after hospitalization—they are a highly vulnerable population and we need to focus intently on making the immediate post-discharge period safer,” he said.
The CMS will raise the readmissions program's maximum penalty to 3% in 2015 and will also add chronic lung disease and elective hip and knee replacement surgeries to the list of measured conditions, according to a final inpatient payment rule released in August.