Article Date: 20 Jun 2013 - 1:00 PDT
With Medicare penalties on hospitals with higher-than-expected rates of 30-day readmissions expected to rise in 2014, more hospitals are evaluating the most accurate methods for tracking readmissions of patients. A new study appearing in the June issue of the Journal of the American College of Surgeons finds that the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) led to more accurate data tracking than another popular database, the University HealthSystem Consortium (UHC), for tracking 30-day hospital readmissions among colorectal surgical patients.
Currently, readmissions for Medicare patients alone cost $26 billion annually. About $17 billion of that could be avoided if patients received the right care from the start, according to a February 2013 report from the Robert Wood Johnson Foundation.* Last year, the Centers for Medicare and Medicaid Services (CMS) began cutting one percent of reimbursements for 30-day readmissions among Medicare patients. That penalty is expected to increase to two percent in 2014 and three percent in 2015.
Readmissions are devastating for patients who have had major operations and then end up back in the hospital 30-days later due to complications. "It's extremely disruptive to patients, their lifestyles, and their caregivers," said Elizabeth Wick, MD, FACS, study author and assistant professor in the department of surgery at Johns Hopkins Medicine, Baltimore.
Readmissions can also lead to poorer outcomes for the underlying disease. "For example, forcolorectal cancer, the goal is to get these patients into chemotherapy within three months of the operation," Dr. Wick explained. "But if a patient is readmitted with a wound infection, that event delays initiating additional treatment to fight the disease, which could have a long-term impact on the outcome."
But tracking readmissions is challenging for hospitals. Moreover, in the current climate there is no standardized way that readmission data is reported to CMS. As the authors point out, "there is no consensus on the best methodology for establishing preventable readmission and by default, pay-for-performance incentives are beginning to use all-cause readmission rates."
One tool, the University HealthSystem Consortium (UHC) database, is commonly used to track readmissions by using administrative data that's used for billing purposes. "A major issue is that manual data is so labor intensive to collect," Dr. Wick said. "Billing data was never intended to be used to drive patient care. But we've been using that data as a last resort, because until recently we didn't have anything else to work with."