A quick note about Brock, et al. (JAMA, 2013)

In the latest JAMA issue, Brock, et al. report on an evaluation of quality improvement initiatives aimed at transitions of care. You can click through for their abstract and other details. Suffice it to say, they found that hospitalization and rehospitalization rates (both computed per beneficiary in the community) declined in the intervention communities relative to the controls. However,

The finding from this project that hospitalizations declined, on average, at the same rate as rehospitalizations suggests that future initiatives using the metric of the percentage of rehospitalizations among hospital discharges should consider tracking the numerator and denominator separately to enable meaningful interpretation of changes. Evidence for the relationship between improved care transitions (from the hospital setting to other settings) and rehospitalizations has arisen in the current context of high rates of errors and shortcomings in care transition processes. As the transition process becomes more reliable, the relationship between improvements in care transitions and rehospitalizations is likely to become more complicated, underscoring the need for direct measures of transitional care quality.

Translation: Hospitals that participate in interventions of the type investigated may not see their readmissions rates — rehospitalizations relative to number of index visit discharges — decline. If that is the case, then despite all the benefits of reduction in hospitalizations that such interventions might offer, the Medicare portion of the payment tied to readmission rates would not change. In other words, Medicare’s readmissions penalty program does not incentivize hospitals for the interventions Brock, et al. study. Maybe Medicare should consider some changes.


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