Why We're All Four Years Too Late to Improve Readmission Rates

Usually after reading Health Affairs, the healthcare policy journal, one’s head is swimming in acronyms and jargon. But a recent blog post by Dr. Amy Boutwell, “Time To Get Serious About Hospital Readmissions,”  is cogent, straightforward, and should be required reading for all hospital administrators.

The headline, though, is misleading, because according to Boutwell, the time to get serious was four years ago, which was two years before the Patient Protection and Affordable Care Act was enacted.

As of Oct. 1 the Centers for Medicare and Medicaid Services began penalizing hospitals  that have higher than average readmission rates for patients hospitalized for heart attack, heart failure, pneumonia, and other conditions.

CMS determines which hospitals get penalized (or rewarded) based on data collected over three years, from July 1, 2008, to June 30, 2011. “The world of hospital quality priorities has evolved tremendously since July 2008,” Boutwell writes. “I conducted a national scan for hospital associations leading efforts to improve care transitions and reduce readmissions and found none. The Institute for Healthcare Improvement had not yet launched the STAAR Initiative [STate Action on Avoidable Rehospitalizations], the Society for Hospital Medicine had not launched BOOST [Better Outcomes for Older Adults through Safe Transitions], and the results of the notable single randomized controlled trial model, Project RED (Re-Engineered Discharge), would not be published for another full year (June 2009).”

Incredibly, according to Boutwell, who conducted her own informal survey, there are many hospitals who have yet to take any steps at all toward reducing readmissions. “Observers may think that the entirety of the hospital ecosystem is well aware of the magnitude of the penalty for their organization and the role they as individual providers have in reducing readmissions,” Boutwell writes. “Although a majority were aware that hospitals were going to be penalized for readmissions, none knew when the penalties started (next year was a common response) and none knew the magnitude of the penalty on their organization. None of these providers had heard from their leadership on this subject.”

Near the end of the article, Boutwell spells it out for hospitals that have yet to take steps to reduce readmissions. “For these hospitals, I would project potential readmission penalty risk over the next five years for two reasons: first, any efforts launched in 2013 will form the basis for the FY ’18 measurement period … and second, because CMS readmission rate adjudication as ‘above expected’ is based on the expected readmission rate, which may change as other organizations reduce readmissions faster or more effectively.”