Penalizing hospitals for high readmissions rates is not necessarily the path toward improved quality of care reveals a new study from the Chicago-based Northwestern Medicine and the American College of Surgeons.
Authors of the study, titled "Underlying Reasons Associated with Hospital Readmission Following Surgery in the United States," examined the reasons for high surgical readmissions rates. They specifically looked at surgery types incorporated into penalties for the Readmissions Reduction Program. What they found was surgical are not due to poor care coordination or mismanagement of known issues, but rather complications that occurred after discharge such as wound infections.
"There has been a growing focus on reducing hospital readmissions from policymakers in recent years, including readmissions after surgery," stated lead author Karl Y. Bilimoria, M.D. 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."
Looking at data from 346 hospitals and nearly 500,000 patient cases, the researchers found that only 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. Of those unplanned readmissions, the most common cause was surgical-site infections at 19.5 percent, followed by delayed return of bowel function with an overall rate of 10.3 percent. Researchers say that efforts to reduce those complications are high in American hospitals and believe implementing, "policies requiring reductions in readmissions without understanding how to impact improvement could be counterproductive."
"Our results also highlighted that many of the complications involved in readmissions, such as surgical-site infections, are already well-know and part of other CMS pay-for-performance programs, which means hospitals are effectively being penalized twice for the same complications," said Dr. Bilimoria.