Hospital 30-day excess readmission ratios for Medicare-reported conditions differed by >0.1 from Medicare-unreported conditions in 29% of hospitals and from non-Medicare conditions in 46%.
Cross-Sectional
Yes
Do hospital-level 30-day readmission measures for publicly reported conditions among Medicare patients reflect readmission rates for unreported conditions or non-Medicare patients?
Publicly reported 30-day readmission measures for Medicare patients with specific conditions have poor agreement with readmission rates for other conditions or non-Medicare populations, suggesting they are poor surrogates for overall hospital quality.
Background: Readmission rates after hospitalizations for heart failure (HF), acute myocardial infarction (AMI), and pneumonia among Medicare beneficiaries are used to assess quality and determine reimbursement. Whether these measures reflect readmission rates for other conditions or insurance groups is unknown. Objective: To investigate whether hospital-level 30-day readmission measures for publicly reported conditions (HF, AMI, and pneumonia) among Medicare patients reflect those for Medicare patients hospitalized for unreported conditions or non-Medicare patients hospitalized with HF, AMI, or pneumonia. Design: Cross-sectional. Setting: Population-based. Participants: Hospitals in the all-payer Nationwide Readmissions Database in 2013 and 2014. Measurements: Hospital-level 30-day all-cause risk-standardized excess readmission ratios (ERRs) were compared for 3 groups of patients: Medicare beneficiaries admitted for HF, AMI, or pneumonia (Medicare reported group); Medicare beneficiaries admitted for other conditions (Medicare unreported group); and non-Medicare beneficiaries admitted for HF, AMI, or pneumonia (non-Medicare group). Results: Within-hospital differences in ERRs varied widely among groups. Medicare reported ratios differed from Medicare unreported ratios by more than 0.1 for 29% of hospitals and from non-Medicare ratios by more than 0.1 for 46% of hospitals. Among hospitals with higher readmission ratios, ERRs for the Medicare reported group tended to overestimate ERRs for the non-Medicare group but underestimate those for the Medicare unreported group. Limitation: Medicare groups and risk adjustment differed slightly from those used by the Centers for Medicare & Medicaid Services. Conclusion: Hospital ERRs, as estimated by Medicare to determine financial penalties, have poor agreement with corresponding measures for populations and conditions not tied to financial penalties. Current publicly reported measures may not be good surrogates for overall hospital quality related to 30-day readmissions. Primary Funding Source: Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology.
Butala et al. (Mon,) conducted a cross-sectional in Heart failure, acute myocardial infarction, and pneumonia. Medicare reported conditions (HF, AMI, pneumonia) vs. Medicare unreported conditions and non-Medicare reported conditions was evaluated on Hospital-level 30-day all-cause risk-standardized excess readmission ratios (ERRs). Hospital 30-day excess readmission ratios for Medicare-reported conditions differed by >0.1 from Medicare-unreported conditions in 29% of hospitals and from non-Medicare conditions in 46%.