Targeting and reducing hospital readmission rates has become a top priority for the Medicare program, and beginning in October, the Patient Protection and Affordable Care Act will start slashing payments to hospitals with higher than average readmission rates under the new fee-for-service program.
The need for proven readmission strategies has never been more urgent with the regulation taking effect later this year. In fiscal year 2013, the payment decrease can be up to one percent of Medicare reimbursement, rising to two percent in 2014 and three percent in 2015.
A new working paper published in January by America’s Health Insurance Plans, the industry group that represents health insurance companies, says there are many ways to measure readmission rates, some of which may be suitable for certain purposes but not others.
The working paper, “Simple Methods of Measuring Hospital Readmission Rates,” was presented Jan. 27 at the World Congress 3rd Annual Leadership Summit on Hospital Readmissions in Falls Church, Va.
“We can connect the dots that readmissions program really do work in the field,” said Jeffrey Lemieux, senior vice president of AHIP’s Center for Policy and Research, at the conference.
AHIP typically counts 30-day readmissions or same-quarter readmissions and computes readmission rates on both a per-admission and a per-enrollee basis.
But in some cases, certain readmissions are excluded, including those for rehabilitation, which may be scheduled or planned in advance. Also, the Centers for Medicare and Medicaid Services currently counts readmissions only after admissions for pneumonia, heart failure, and heart attack, although this list is likely to be expanded in the future.
The 30-day readmission rate is a common measurement in most research methods. The definition of a 30-day readmission seems intuitive, but there are many complications that arise from measuring 30-day readmission rates from various datasets, according to the AHIP report.
For example, transfers from one hospital to another are rarely counted as readmissions. Transfers from nursing homes are usually counted but not always. Admissions that occur on the same day as a discharge are usually counted as readmissions as long as there was no transfer code in the discharge record.
“The standard 30-day counting method tallies admissions that followed the prior discharge by 30 days or less. Each discharge is tracked for a potential readmission and each admission can be a readmission only once, from the previous discharge,” according to AHIP.
Thirty-day readmissions can only be counted in datasets that provide both the dates of discharge and admission. But some datasets do not provide such detailed data. The Agency for Healthcare Research and Quality, an arm of the U.S. Department of Health and Human Services, has generated a solution that allows hospitals to compute 30-day readmissions from some of their limited datasets.
Some AHRQ limited datasets now provide revisit codes that express the length of time between admissions. To measure 30-day readmissions, these admission-to-admission spans can be combined with the reported length of hospital stays to compute the day spans between discharge and readmission.
When neither the actual dates of admission and discharge nor AHRQ’s revisit indicators are available, AHIP uses a same-quarter readmission rate as a replacement measure.
“While the same-quarter readmission count is not as clinically intuitive as a 30-day count, it has the advantage of being unambiguous to compute, and it can be computed from most publically available hospital discharge or claims dataset,” AHIP says.
The same-quarter readmission counts and rates typically turn out to be similar to and consistent with the 30-day rate.
Other calculations rates exist, which are outlined in AHIP’s working paper
Regardless of the methods used to calculate their readmissions, hospitals will need to monitor admissions and discharges more closely than ever before – and they may have to do that with fewer resources.
“One thing that does sound very clear is that there are going to be more budget cuts,” AHIP’s Lemieux said.
Likely, Medicare and Medicaid will be on the chopping block in future federal budget talks. Lemieux suggests that instead of cutting reimbursement payments to hospitals, Congress should adopt a plan to allow hospitals to gain back those cuts if they perform better, meaning if they improve their readmission rates.