Don’t fine hospitals for patient readmissions

Re the Oct. 11 article Readmitting fines up in South Florida: Medicare continues to levy hefty fines on Florida hospitals for readmitting patients, further complicating an already difficult problem for quality medical services being provided throughout the state.

Hospital fines are on the increase more this year than ever given that new categories are now being evaluated, including those patients initially admitted for elective knee or hip replacement, again broadening and adding to the pool of patients from which readmission rates are assessed.

In my estimation, it’s simply a shame. Earlier this year, the team I lead at the Center for Advanced Orthopedics at Larkin (CAOL) in South Miami published a body of research that found that Florida’s poor and mentally ill patients have much higher readmission rates. Why then are hospitals being penalized for following through and taking care of these most vulnerable patients?

Hospital readmission rates have traditionally been a determining factor in performance of quality care. Simply put, if a patient is initially admitted for a procedure, then the patient should not have to experience an unplanned readmission within the next 15 to 30 days of the procedure — whether it is related or not to the initial visit.

My team has been conducting research to better understand value and quality after hip arthroplasty. The Centers for Medicare and Medicaid Services (CMS) has determined that a high readmission rate is a sign of poor quality of care. Hospitals with high risk-adjusted readmission rates for selected high-volume and high-cost conditions are being penalized with a cut of their base of Medicare reimbursements. However, it is unclear what the drivers behind readmissions are after hip replacement and whether readmission rates, per se, reflect quality.

The CAOL study found that patients were more frequently readmitted if their payer was the government, they were discharged to a skilled nursing facility, or they had a mental health disorder. Safety-net hospitals and university hospitals that care for these patients of color, minorities, the mentally ill and the poor will have higher readmission rates and will experience payment reductions unfairly applied by CMS under the next phase of the readmissions reduction program by the year 2015.

It is my belief that before implementation, quality measures need to be well understood and proven scientifically sound. Additional studies similar to what has been done at CAOL should be encouraged in the scientific community and the results should be presented to health policy makers as well as the patient community. Instead of worrying about the rates and imposing more fines, let’s double-down on delivering the great medical care all in our community deserve.

This story was originally published October 19, 2014 at 8:03 PM with the headline "Don’t fine hospitals for patient readmissions."