Medicare’s Measure for Readmissions Fails to Identify Excellence and Improvement

December 16, 2014

ANN ARBOR, MI. — Altarum Institute’s Center for Elder Care and Advanced Illness today released data showing that San Diego County is doing much better than the national average at reducing readmissions to hospitals, yet nearly all their eligible hospitals are being penalized by Medicare’s hospital readmissions penalty program.

The problem is that Medicare measures progress by dividing the number of readmissions by the number of discharges from each hospital; it turns out that good practices reduce the discharges at nearly the same rate as readmissions, making the ratio stay the same despite substantial improvement.

The Center’s director, Dr. Joanne Lynn, stated, “Some hospitals and communities are creating the standard for best practices, and the rest of the country should be learning from them. Instead, the measure that Medicare uses makes them appear to make little progress and most of their hospitals are being penalized. Medicare is knowingly using a measure that does not reliably indicate progress or failure.”

An accompanying blog by Dr. Steve Jencks, who co-authored the initial report on the high rate of readmissions in Medicare patients, explains the origin of the problem and contends that the Medicare program should quickly take steps to restore basic fairness in the hospital penalty program and should develop the metrics that the health care system needs to guide further improvement work.

Both Lynn and Jencks point to the remarkable successes of the work on improving transitions as people leave the hospital to continue care at home. Many hospitals have developed strong partnerships with their community’s supportive service providers. Use of hospitals has gone down, Medicare funds are being saved, and patients are doing better without troubling and often serious complications in their days at home.

“The challenge is to correct the malfunctioning metric and keep up the head of steam that is improving quality and reducing costs,” added Dr. Lynn.

“Determining how many other hospitals and communities have this problem requires analyses that only Medicare can do,” said Dr. Jencks. “The analyses to make that determination should be a priority.” 

Dr. Jencks, Dr. Lynn, and leaders in San Diego are calling on Medicare to get that work underway.

For background information on the hospital penalty program, click here. For a list of hospitals and their penalties, click here. For more information, please contact Dr. Joanne Lynn.

Contact Information
Ken Schwartz
202-772-5062
ken.schwartz@altarum.org

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Altarum Institute (www.altarum.org) integrates objective research and client-centered consulting skills to deliver comprehensive, systems-based solutions that improve health and health care. Altarum employs more than 400 individuals and is headquartered in Ann Arbor, Michigan, with additional offices in the Washington, DC, area, and Portland, Maine.

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