Medicare is four years into its drive to cut the number of patients who land back in the hospital within a few weeks of leaving, and only a quarter of more than 3,400 hospitals avoided penalties. The results are contributing to skepticism about the readmissions program and the broader array of metrics used to evaluate healthcare quality.
“How's that readmission penalty thing working out for Medicare?” asked Dr. Aaron Carroll, a health policy researcher and editor-in-chief for the Incidental Economist, a critical health policy blog. “Everyone sucks,” he said in a post citing concerns with the program.
The CMS has touted research suggesting the all-cause readmissions rate declined in 2012 and 2013, reaching 17.5% after holding steady at 19% for the previous five years.
But with as much as 6% of a hospital's base operating pay from Medicare expected to be on the line by 2017, health policy and quality and safety researchers, as well as organizations representing hospitals, are urging more scrutiny of metrics used in the government's quality incentive programs.
“The whole field is a mess—it's all over the place,” said Dr. Robert Wachter, interim chair of the department of medicine at the University of California, San Francisco. “We need better science.”
The government has failed to set thresholds for how reliable a measure must be before it's used in a pay-for-performance program, said Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine.
“Someone could come up with any new measure and say, 'Trust me, it's accurate,' ” he said.
Pronovost said the National Quality Forum, an independent contractor that works with the federal government to evaluate the quality of measures used in federal reporting programs, should also establish thresholds for the validity of the measures it endorses.
NQF President and CEO Dr. Christine Cassel told Modern Healthcare that she shares concerns about whether Medicare is using the best measures. But she also said more metrics are needed, not fewer. “The fact is that healthcare and human health is a complicated business, and measurement is a science that has to encompass all the complexity of that complicated business.” (Cassel discusses the NQF's search for better metrics in this week's Q&A). Cassel said she is optimistic that the science will get better as more clinical data become available from electronic health records.