Yesterday, I quoted the recent Commonwealth Fund Issue Brief on Medicare’s hospital readmission measures, by Clifford Marks, Saranya Loehrer, and Douglas McCarthy. It is based on comments by a panel of experts, all of whom are listed in the brief. Below are the other passages I highlighted as I read. All are direct quotes.
- Hospitals, academics, and policymakers are heatedly debating the appropriateness of the readmissions metric―even its definition―giving the impression of fundamental disagreement about the program’s value.
- That the initial policy has flaws is an argument not for abandoning the effort, but for redoubling efforts to improve the measures as well as the incentive system.
- Patients do not suffer less at 31 days or when their initial diagnosis is diabetes, rather than heart failure. Moreover, the measure fails to capture equally harmful preventable admissions, which many panelists believe should be incorporated into a set of related accountability measures.
- Measures such as days between hospital encounters or days alive at home permit assessment along a continuum, which may better track what patients desire from health care. Attending to patient needs also requires that readmissions be considered in the context of balancing measures―such as mortality, length of stay, and use of observation status―to help ensure health systems are not eliminating necessary admissions, readmissions, or days in the hospital.
- A significant criticism of the Medicare readmissions penalty is that hospitals are held financially accountable for certain aspects of care that are beyond their control.
All prior TIE posts on hospital readmissions are tagged accordingly.