This is a troubling study that finds an inverse relationship between readmissions and mortality. It states that if you include increased mortality as a quality measure almost 1/3 of hospitals with a favorable readmission rate would be penalized
This study attempts to determine how readmission penalties for hospitals in the United States would change if policy equally weighted 30-day readmissions and mortality from heart failure, pneumonia, and acute myocardial infarction.
In fiscal year (FY) 2013, the Centers for Medicare & Medicaid Services (CMS) began penalizing hospitals in the United States under the Hospital Readmissions Reduction Program for excess risk–standardized 30-day readmissions in Medicare patients with heart failure (HF), pneumonia (PNA), and acute myocardial infarction (AMI). In FY 2014, the Hospital Value-Based Purchasing Program began penalizing hospitals with higher than expected risk–standardized 30-day mortality for these diagnoses. Readmission and death are competing but weakly correlated outcomes, leading to the belief that hospitals with low mortality are not more likely to receive readmission penalties.1
In 1963 US hospitals with complete data for analysis, FY 2014 readmission penalties (0%-2% of DRG reimbursement) closely tracked excess readmissions (r = 0.81; P < .001), but were minimally and inversely associated with excess mortality (r = −0.12; P < .001) and only modestly correlated with excess combined readmission and mortality (r = 0.36; P < .001). The associations between condition-specific excess readmission and mortality were weak (HF: r = –0.21; P < .001) or absent (PNA: r < 0.001; P = .99 and AMI: r = 0.002; P = .94) and similar to those reported in previous Medicare cohorts for these diagnoses.1
With mortality weighted twice as much as readmission, 21% of hospitals had an ERRAGG ratio greater than 1 and an ECORAGG ratio less than 1, and 23% of hospitals had an ERRAGG ratio less than 1 and an ECORAGG ratio greater than 1. With mortality weighted 5 times as much as readmission, 24% of hospitals had an ERRAGG ratio greater than 1 and an ECORAGG ratio less than 1, and 27% of hospitals had an ERRAGG ratio less than 1 and an ECORAGG ratio greater than 1. In other words, in FY 2014 more than half of US hospitals would have been misclassified for CMS penalties if death were considered 5 times more important than readmission.
For FY 2014, CMS financial penalties for one-third of US hospitals would likely have been substantially different if the methodology equally weighted 30-day readmission and mortality. These discrepancies increased as mortality was weighted more heavily.