Publicly Reported Readmission Measures and the Hospital Readmissions Reduction Program: A False Equivalence?
Authors: Rohan Khera, Leora I. Horwitz, Zhenqiu Lin, Harlan M. Krumholz
Journal: Annals of Internal Medicine (2018)

Editorials1 May 2018Publicly Reported Readmission Measures and the Hospital Readmissions Reduction Program: A False Equivalence?Rohan Khera, MD, Leora I. Horwitz, MD, MHS, Zhenqiu Lin, PhD, and Harlan M. Krumholz, MD, SMRohan Khera, MDUniversity of Texas Southwestern Medical Center, Dallas, Texas (R.K.), Leora I. Horwitz, MD, MHSNew York University School of Medicine, New York, New York (L.I.H.), Zhenqiu Lin, PhDYale–New Haven Hospital, New Haven, Connecticut (Z.L.), and Harlan M. Krumholz, MD, SMYale–New Haven Hospital, Yale School of Medicine, and Yale School of Public Health, New Haven, Connecticut (H.M.K.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-0536 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hospital readmissions have emerged as a central focus of quality improvement in the United States. For years, studies reported that patients discharged from the hospital had a high risk for being readmitted (1). In 2009, the Centers for Medicare & Medicaid Services began publicly reporting risk-standardized readmission rates for acute myocardial infarction, heart failure, and pneumonia (2–4), highlighting the performance of hospitals for Medicare beneficiaries hospitalized with these conditions nationwide. The conditions were selected because they represent high-prevalence, high-risk, and high-cost conditions known to have high readmission rates. As part of the Patient Protection and Affordable Care Act, the Hospital ...References1. Krumholz HM, Parent EM, Tu N, Vaccarino V, Wang Y, Radford MJ, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99-104. [PMID: 8996046] CrossrefMedlineGoogle Scholar2. Keenan PS, Normand SL, Lin Z, Drye EE, Bhat KR, Ross JS, et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes. 2008;1:29-37. [PMID: 20031785] doi:10.1161/CIRCOUTCOMES.108.802686 CrossrefMedlineGoogle Scholar3. Krumholz HM, Lin Z, Drye EE, Desai MM, Han LF, Rapp MT, et al. An administrative claims measure suitable for profiling hospital performance based on 30-day all-cause readmission rates among patients with acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2011;4:243-52. [PMID: 21406673] doi:10.1161/CIRCOUTCOMES.110.957498 CrossrefMedlineGoogle Scholar4. Lindenauer PK, Normand SL, Drye EE, Lin Z, Goodrich K, Desai MM, et al. Development, validation, and results of a measure of 30-day readmission following hospitalization for pneumonia. J Hosp Med. 2011;6:142-50. [PMID: 21387551] doi:10.1002/jhm.890 CrossrefMedlineGoogle Scholar5. QualityNet. Measure methodology reports. Readmission measures. 2017. Accessed at www.qualitynet.org/dcs/ContentServer?cid=1219069855841&pagename=QnetPublic%2FPage%2FQnetTier4&c=Page on 24 February 2018. Google Scholar6. Horwitz LI, Partovian C, Lin Z, Grady JN, Herrin J, Conover M, et al. Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission. Ann Intern Med. 2014;161:S66-75. [PMID: 25402406]. doi:10.7326/M13-3000 LinkGoogle Scholar7. Butala NM, Kramer DB, Shen C, Strom JB, Kennedy KF, Wang Y, et al. Applicability of publicly reported hospital readmission measures to unreported conditions and other patient populations. A cross-sectional all-payer study. Ann Intern Med. 2018;168:631-9. doi:10.7326/M17-1492 LinkGoogle Scholar8. Desai NR, Ross JS, Kwon JY, Herrin J, Dharmarajan K, Bernheim SM, et al. Association between hospital penalty status under the hospital readmission reduction program and readmission rates for target and nontarget conditions. JAMA. 2016;316:2647-2656. [PMID: 28027367] doi:10.1001/jama.2016.18533 CrossrefMedlineGoogle Scholar9. Zuckerman RB, Joynt Maddox KE, Sheingold SH, Chen LM, Epstein AM. Effect of a hospital-wide measure on the readmissions reduction program. N Engl J Med. 2017;377:1551-1558. [PMID: 29045205] doi:10.1056/NEJMsa1701791 CrossrefMedlineGoogle Scholar10. Rosen AK, Chen Q, Shwartz M, Pilver C, Mull HJ, Itani KF, et al. Does use of a hospital-wide readmission measure versus condition-specific readmission measures make a difference for hospital profiling and payment penalties? Med Care. 2016;54:155-61. [PMID: 26595224] doi:10.1097/MLR.0000000000000455 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: University of Texas Southwestern Medical Center, Dallas, Texas (R.K.)New York University School of Medicine, New York, New York (L.I.H.)Yale–New Haven Hospital, New Haven, Connecticut (Z.L.)Yale–New Haven Hospital, Yale School of Medicine, and Yale School of Public Health, New Haven, Connecticut (H.M.K.)Grant Support: Dr. Khera is supported by grant 5T32HL125247-02 from the National Heart, Lung, and Blood Institute and grant UL1TR001105 from the National Center for Advancing Translational Sciences of the National Institutes of Health.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0536.Corresponding Author: Harlan M. Krumholz, MD, SM, 1 Church Street, Suite 200, New Haven, CT 06510; e-mail, harlan.[email protected]edu.Current Author Addresses: Dr. Khera: 5323 Harry Hines Boulevard, E5.730, Dallas, TX 75390.Dr. Horwitz: 227 East 30th Street, Sixth Floor, New York, NY 10016.Drs. Lin and Krumholz: 1 Church Street, Suite 200, New Haven, CT 06510.This article was published at Annals.org on 27 March 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoApplicability of Publicly Reported Hospital Readmission Measures to Unreported Conditions and Other Patient Populations Neel M. Butala , Daniel B. Kramer , Changyu Shen , Jordan B. Strom , Kevin F. Kennedy , Yun Wang , Linda R. Valsdottir , Jason H. Wasfy , and Robert W. Yeh Metrics Cited byExamination of Post-discharge Follow-up Appointment Status and 30-Day ReadmissionAssociation of Inclusion of Medicare Advantage Patients in Hospitals' Risk-Standardized Readmission Rates, Performance, and Penalty StatusEvaluation of 30-Day Hospital Readmission and Mortality Rates Using Regression-Discontinuity FrameworkEffects of the Hospital Readmissions Reduction Program 1 May 2018Volume 168, Issue 9Page: 670-671KeywordsComputed axial tomographyDisclosureMedicareMotivationPneumoniaPopulation statisticsQuality improvementRisk managementSafetyScience policy ePublished: 27 March 2018 Issue Published: 1 May 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...