A study from Northwestern Medicine and the American College of Surgeons published in JAMA suggests that penalizing hospitals for patient readmissions following surgery may be ineffective, and even counterproductive, for improving the quality of hospital care in America. The authors of the study, titled “Underlying Reasons Associated with Hospital Readmission Following Surgery in the United States”, found that most surgical readmissions are not due to poor care coordination or mismanagement of known issues. Instead, readmissions were due to expected surgical complications, such as wound infections, that occurred after discharge and were not present during a patient’s hospital stay more than 97 percent of the time.
“There has been a growing focus on reducing hospital readmissions from policymakers in recent years, including readmissions after surgery,” said lead author Dr. Karl Y. Bilimoria, a surgical oncologist and vice chair for quality at Northwestern Memorial Hospital, and director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine. “But before this study, we didn’t really understand the underlying reasons why patients were being readmitted to hospitals following surgery.”
Currently, a hospital’s rate of all its unplanned patient readmissions, which includes surgical patients, is publicly reported by the Centers for Medicare & Medicaid Services (CMS). In addition, a hospital’s reimbursement from CMS gets reduced if CMS determines that a hospital has too many readmissions within a period of 30 days following a patient’s discharge for certain care, including total hip and knee replacement surgery. This policy, known as the Readmissions Reduction Program, became effective on October 1, 2012 as part of the Affordable Care Act (ACA), but it initially only focused on readmissions for heart attack, heart failure and pneumonia. The study authors note other surgery types will be incorporated into CMS’ Readmissions Reduction Program in the near future.
To better understand the reasons behind postoperative readmissions, researchers collected data from the American College of Surgeons’ National Surgical Quality Improvement Program (ACS NSQIP) from 346 U.S. hospitals for the full year of 2012. These data specifically included the underlying reason for why the readmission occurred based on the medical record, discussions with treating doctors, and the patients themselves – data that are not available elsewhere. Six different surgical procedure types were reviewed based on their clinical and CMS policy relevancy, resulting in a total of 498,875 separate patient cases being analyzed for the study. The six procedures reviewed were:
Researchers found that 5.7 percent of the patient cases had unplanned readmissions. Of those unplanned readmissions, only 2.3 percent of patients were readmitted due to a complication that occurred during their initial stay in the hospital.
See journal article: http://jama.jamanetwork.com/article.aspx?articleid=2107788