Hospital Readmissions continues to be a driving topic of concern, debate and contention in the healthcare industry. It also continues to be an area of great interest for potential partnerships between acute and post-acute care organizations. Whether that interest is warranted based upon expected improvement in outcomes and cost reductions remains to be seen.
JAMA Study: Assessing Program Risk
On Tuesday of this week the Journal of the American Medical Association published a study, which looked at the relationship between risk-adjusted mortality and 30-day hospital readmissions. The reasons for testing this relationship are because of concern that artificial incentives will drive behaviors with unintended consequences.
First, the concern is that hospitals may invest resources to lower readmissions for targeted conditions at the expense of quality care for other conditions. Second, there is concern that patients may not cared for in an environment that is determined by clinical needs and requirements, but instead by financial considerations. For those who believe these concern are overstated the results of this research will serve to reinforce their perception.
Data was analyzed for Medicare beneficiaries admitted to hospitals between July 2005 and June 2008 with a heart attack, heart failure and pneumonia. These are the three conditions hospitals are now being penalized for 30-day readmissions under the Medicare Hospital Readmissions Reduction Program. According to the study, “risk-standardized mortality rates and readmission rates were not associated for patients admitted with an acute myocardial infarction or pneumonia and were only weakly associated, within a certain range, for patients admitted with heart failure.”
RWJ Foundation: Revolving Door
Another report released this week, by the Robert Wood Johnson Foundation, found that hospitals and their partner relationships made little progress from 2008 to 2010 at reducing hospital readmissions for elderly patients. Using new Medicare data from the Dartmouth Atlas Project, researchers found , “one in eight Medicare patients were readmitted to the hospital within 30 days of being released after surgery in 2010, while one in six patients returned to the hospital within a month of leaving the hospital after receiving medical care. Patients were not significantly less likely to be readmitted in 2010 than in 2008.”
The report also shares findings from interviews with patients and providers that sought to better understand the root causes of patient readmissions. While some portion of those readmissions were either anticipated or necessary, there were also a significant number of readmissions that could primarily be attributed to non-clinical considerations, such as discharge planning, the individual’s support system, care coordination and the availability of primary care post-discharge.
So what to make of this? Research is continuing to support the hypothesis that cost savings are achievable by creating better alignment of care requirements and care settings without sacrificing quality. The ways in which providers achieve such savings, however, are no clearer today than they were several years ago. Also up for debate is whether the Hospital Readmissions Reduction Program is providing a meaningful incentive to drive innovation – or whether providers are reacting to market realities (likely some combination thereof).
What does not seem to be up for debate is the reality that proactive healthcare providers are pushing integrated delivery models that seek to facilitate better resource alignment. Are you one of those organizations?