Readmission rates after complex cancer operations tend to be higher in hospitals that are considered to be vulnerable because they serve as safety nets in their communities or have a high number of Medicaid patients. Reasons for higher readmission rates are highly complex and involve socioeconomic and hospital institutional characteristics. Payment programs that penalize hospitals for high readmission rates without understanding these issues could stress already financially threatened institutions, according to authors of a new study published online in the Journal of the American College of Surgeons in advance of print publication.
Clinical quality improvement efforts as well as federal payment policies have sought to reduce hospital readmissions to improve the quality of patient care and decrease Medicare program spending. A review of Medicare claims by the Medicare Payment Advisory Commission (MedPAC) in 2005 found that 5 to 79 percent of readmissions could potentially have been prevented and saved $12 billion in Medicare spending.
Findings such as these led to creation of the Medicare Hospital Readmissions Reduction Program (HRRP) in the Affordable Care Act, which penalizes hospitals that have higher than expected readmission rates. HRRP currently covers four common medical conditions–pneumonia, heart failure, acute myocardial infarction, and chronic obstructive pulmonary disease (COPD), along with two joint replacement operations (knee and hip). The program will expand in 2017 and begin including coronary artery bypass grafting (CABG) procedures.
While the American College of Surgeons has publicly recognized that high readmission rates may reflect lower quality care and lead to unnecessary spending, ACS has emphasized that readmissions may be related to many factors, including the complexity of the medical condition as well as patients’ socioeconomic status and compliance. ACS has urged HRRP to take such factors into consideration so hospitals are not penalized because of factors that are beyond their control.