"And Beth Israel is a terrific hospital," Jha says. "The more you look, you do see the pattern."
In fact, almost no hospital in the country excels in both readmissions and mortality disease categories.
What Jha fears is that some low mortality hospitals will start realigning their resources in favor of programs that avoid readmissions.
Lopsided incentive system "is frustrating"
I asked Ken Sands, MD, Beth Israel's senior vice president for healthcare quality, if he thinks that will happen. The lopsided incentive system "is frustrating," he tells me. "We're proud of the fact we have a low mortality and we want to do everything possible to decrease preventable readmissions. But we certainly don't want to lessen performance on mortality while doing so."
Sands thinks it's too early to say whether other hospitals will shift any of their focus from life-saving measures. But he acknowledges, "it's certainly true that funds are going to be spent to prevent readmissions, and they have to come from somewhere."
They might come from something that targets patient satisfaction scores, or in resources now spent to improve access to care, he cautions.
In a Perspective article "Thirty-Day Readmissions—Truth and Consequences" in the New England Journal of MedicineApril 12, Jha and Harvard colleague Karen Joynt, MD, elaborated on their concern that hospitals would pull resources away from quality improvements that save lives and shift them to programs that avoid readmissions. Among their points: