Hospital Readmissions, Mortality Incentives Alarmingly Misaligned

Cheryl Clark, for HealthLeaders Media , April 26, 2012

Higher quality hospitals should be incentivized to focus on improving safety and other services that look at outcomes like mortality, Jha says. For example, it may be that higher quality care results when hospitals and doctors closely track their patients after they are discharged, and rush to rescue them when they get in trouble.

Jha had his analyst run the numbers on the latest list of "best hospitals" named by U.S.News & World Report, which revealed that most of these hospitals do look lopsided. "What you see is a pattern where the best hospitals tend be very low on mortality rates, but tend to be high in readmissions," he says.

Jha made similar comments to journalists attending the Association of Health Care Journalists conference in Atlanta on Sunday.

I noted that for some hospitals the difference is particularly stark.

On Medicare's current Hospital Compare spreadsheet I found Exhibit A: Beth Israel Deaconess Medical Center in Boston, which is "better than" other U.S. hospitals in 30-day mortality rates for all three measured disease categories—heart attack, pneumonia and heart failure.

But Beth Israel is "worse than" other hospitals in 30-day readmission rates in those same diagnoses, and therefore is ripe for a steep readmission penalty starting Oct. 1.

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2 comments on "Hospital Readmissions, Mortality Incentives Alarmingly Misaligned"

Carl (4/30/2012 at 10:59 AM)
It makes sense from a financial point of view. If the patient dies, their expenses cease. It is the money with which CMS is concerned. I have noted in my research that the hospitals with the lowest mortality rates also have higher readmission rates.

Michael Barber MD (4/26/2012 at 3:26 PM)
There is significant data and experience that would indicate that reducing readmissions is a good way to reduce 30 day mortality plus it is easier to measure and does not require risk adjustment like mortality. The problem that hospitals, even high quality ones like Beth Israel, see readmissions as the only way to reduce mortality instead of increasing the community based resources that can increase adherence to therapy and solve many of the non clinical problems that contribute to both readmissions as well as premature mortality. Studies of "hospital at home" for congestive heart failure show that treatment costs are 20% less and complication rates nearly zero as well as fewer clinical relapses. Other studies show that primary admissions for these disesases can be reduced up to 50% by taking a highly integrated person centered approach to our most vulnerable elders. In my mind, the financial incentives to use inpatient resources to heal our patients have caused hospital leaders to have blinders on the work that can be done at the community level.




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