Recalculating Readmissions: A Work in Progress
Authors: Saul N. Weingart
Journal: Annals of Internal Medicine (2020)

EditorialsJanuary 2021Recalculating Readmissions: A Work in ProgressSaul N. Weingart, MD, MPP, PhDSaul N. Weingart, MD, MPP, PhDTufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts (S.N.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M20-6254 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The rate of unplanned 30-day readmissions has a storied pedigree in quality measurement. Popularized in part by the Institute for Healthcare Improvement and implemented nationwide by the Centers for Medicare & Medicaid Services (CMS) in 2012, unplanned readmissions were taken as evidence—at least in some cases—of inadequate treatment, poor discharge planning, and problematic postacute care.Drawing on observations from manufacturing, experts argued that early failures (that is, readmissions) were attributable to defective processes early in the product life cycle. In contrast, late failures due to wear and tear were gradual and occurred toward the end of the life cycle. The ...References1. Auerbach AD, Kripalani S, Vasilevskis EE, et al. Preventability and causes of readmissions in a national cohort of general medicine patients. JAMA Intern Med. 2016;176:484-93. [PMID: 26954564] doi:10.1001/jamainternmed.2015.7863 CrossrefMedlineGoogle Scholar2. Forster AJ, Murff HJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138:161-7 LinkGoogle Scholar3. Hansen LO, Young RS, Hinami K, et al. Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med. 2011;155:520-8. doi:10.7326/0003-4819-155-8-201110180-00008 LinkGoogle Scholar4. Rau J. New round of Medicare readmission penalties hits 2,583 hospitals. Kaiser Health News. 1 October 2019. Accessed at https://khn.org/news/hospital-readmission-penalties-medicare-2583-hospitals on 3 September 2020. Google Scholar5. Zuckerman RB, Sheingold SH, Orav EJ, et al. Readmissions, observation, and the Hospital Readmissions Reduction Program. N Engl J Med. 2016;374:1543-51. [PMID: 26910198] doi:10.1056/NEJMsa1513024 CrossrefMedlineGoogle Scholar6. Graham KL, Auerbach AD, Schnipper JL, et al. Preventability of early versus late hospital readmissions in a national cohort of general medicine patients. Ann Intern Med. 2018;168:766-774. doi:10.7326/M17-1724 LinkGoogle Scholar7. Joynt Maddox KE, Reidhead M, Jianhui H, et al. Adjusting for social risk factors impacts performance and penalties in the Hospital Readmissions Reduction Program. Health Serv Res. 2019;54:327-36. [PMID: 30848491] doi:10.1111/1475-6773.13133 CrossrefMedlineGoogle Scholar8. Zuckerman RB, Joynt Maddox KE, Sheingold SH, et al. Effect of a hospital-wide measure on the Readmissions Reduction Program. N Engl J Med. 2017;377:1551-8. [PMID: 29045205] doi:10.1056/NEJMsa1701791 CrossrefMedlineGoogle Scholar9. Abdul-Azziz AA, Hayward RA, Aaronson KD, et al. Association between Medicare hospital readmission penalties and 30-day combined excess readmission and mortality. JAMA Cardio. 2017;2:200-3. [PMID: 27784054] doi:10.1001/jamacardio.2016.3704 CrossrefMedlineGoogle Scholar10. Wadhera RK, Joynt Maddox KE, Desai NR, et al. Evaluation of hospital performance using the excess days in acute care measure in the Hospital Readmissions Reduction Program. Ann Intern Med. 2021;174:86-92. doi:10.7326/M20-3486 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts (S.N.W.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-6254.Corresponding Author: Saul N. Weingart, MD, MPP, PhD, Tufts Medical Center, 800 Washington Street, Boston, MA 02111; e-mail, [email protected]org.This article was published at Annals.org on 13 October 2020. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEvaluation of Hospital Performance Using the Excess Days in Acute Care Measure in the Hospital Readmissions Reduction Program Rishi K. Wadhera , Karen E. Joynt Maddox , Nihar R. Desai , Bruce E. Landon , Muthiah Vaduganathan MD , Lauren G. Gilstrap , Changyu Shen , and Robert W. Yeh Metrics January 2021Volume 174, Issue 1Page: 113-114KeywordsEmergency departmentHealth careHealth care qualityHeart failureLength of stayMedicarePneumoniaProgressive diseasesReproducibilitySafety ePublished: 13 October 2020 Issue Published: January 2021 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...