A software widely used by U.S. hospitals to help flag patient cases that could result in preventable readmissions may only generate confusing results.
Instead of reflecting poorer quality, care was surprisingly better among those cases flagged by 3M software as being “potentially preventable,” concluded Boston University researchers in findings published Monday in the BMJ Quality and Safety, a journal of the British Medical Association.
The study is the latest to add to the growing body of skepticism about the federal government's readmissions reduction program and the emerging technologies helping hospitals to improve. Well into the fourth year of the CMS' program, most hospitals continue to face steadily increasing financial penalties, despite reported efforts to improve.
“Perhaps the key question is not how to define a measure of preventable readmissions, but whether it is an important patient-centered outcome,” wrote doctors Christine Soong and Chaim Bell of Mount Sinai Hospital in Toronto, Canada, in editorial accompanying the new BMJ report.
Use of administrative claims data from diagnostic and procedural coding systems such as ICD-9 are not an ineffective tool for this purpose because they do not sufficiently capture the complex elements associated with patient care, data analysts argue.
Therefore the upcoming switch to a new coding system is not likely to capture the level of nuance and the problem could persist under the new coding systems, the study authors speculate.
The CMS currently pulls administrative diagnostic codes to evaluate how frequently patients treated for heart attack, heart failure, chronic obstructive pulmonary disease, total hip and knee replacements and pneumonia return to the hospital within 30 days of being sent home.
Unnecessary and preventable hospital readmissions lead to an estimated $41 billion in additional hospital costs annually, according to estimates from the Agency for Healthcare Research and Quality.
More than 2,600 U.S. hospitals with readmission rates that are too high will see their Medicare payments docked up to 3% in fiscal 2016 for poor performance on the metric. That number is expected to rise to as much as 6% of a hospital's base operating DRG by 2017.
3M, a software and data analytics company based in St. Paul, Minnesota and used by most U.S. hospitals, offers a type of grouping software that helps hospitals identify and prevent unnecessary readmissions. It flags potentially preventable cases that could result from process of care and treatment issues during the inpatient stay, such as a readmission for a surgical wound infection, or after discharge, like a lack of follow-up arrangement for a patient.
To assess the software's ability to gauge poor quality as a readmission factor, the Boston University researchers, led by Dr. Anne Borzecki, an assistant professor of medicine, used ICD-9 codes to identify 11,278 readmissions following treatment for pneumonia (out of 68,158 total discharges) at the Veterans Health Administration between fiscal years 2007 and 2010.
They then used the 3M software to determine if the readmissions were considered preventable. A 10-member expert panel that included internists, pulmonologists and infectious disease specialists reviewed 100 randomly selected examples to determine if the care provided in those cases represented the standard of care for pneumonia treatment.
Of the 100 cases, 77 were flagged by 3M as preventable, however contrary to expectations, quality scores did not differ significantly between preventable and non-preventable cases. Either the events are not really more preventable, or determining preventability requires other data collection methods, wrote the Boston University researchers. The measures, they said, “are no better than CMS measures in ascertaining which cases are preventable.”
The U.S. healthcare industry is poised to switch from use of the ICD-9 to the ICD-10 diagnostic and procedural coding system on Oct. 1, which will significantly change how billions of dollars in medical claims will be calculated and billed every day.
The researcher's analysis was performed using only ICD-9 codes, but they concluded the problems they identified would exist regardless of the codes used. The problems illustrate the difficulty in using administrative data to measure readmissions and help generate solutions, they said.
3M had not responded to a Modern Healthcare request for comment on the new study by deadline, however a spokeswoman said the company continues to prepare clients for the pending ICD-10 conversion.
Last week, 3M also announced plans to explore “strategic alternatives” to continued ownership of its Health Information Systems business unit, which includes a spin off, sale or retention of the division, which will be determined by the first quarter of 2016.
“Everyone at 3M Information Systems is working to ensure that what we've worked for years to prepare for will come to fruition,” said company spokeswoman Donna Fleming Runyon. “Our work will continue as always and our plans and product timeline will be carried out as scheduled and the dedication to helping all of our customers achieve ICD-10 success is there, as strong as it ever was.”
