Using same-hospital readmission rates to estimate all-hospital readmission rates. J Am Coll Surg 2014 Oct;219(4):656-63
Date
08/28/2014Pubmed ID
25159017Pubmed Central ID
PMC4171214DOI
10.1016/j.jamcollsurg.2014.05.008Scopus ID
2-s2.0-84908097162 (requires institutional sign-in at Scopus site) 28 CitationsAbstract
BACKGROUND: Since October of 2012, Medicare's Hospital Readmissions Reduction Program has fined 2,200 hospitals a total of $500 million. Although the program penalizes readmission to any hospital, many institutions can only track readmissions to their own hospitals. We sought to determine the extent to which same-hospital readmission rates can be used to estimate all-hospital readmission rates after major surgery.
STUDY DESIGN: We evaluated 3,940 hospitals treating 741,656 Medicare fee-for-service beneficiaries undergoing CABG, hip fracture repair, or colectomy between 2006 and 2008. We used hierarchical logistic regression to calculate risk- and reliability-adjusted rates of 30-day readmission to the same hospital and to any hospital. We next evaluated the correlation between same-hospital and all-hospital rates. To analyze the impact on hospital profiling, we compared rankings based on same-hospital rates with those based on all-hospital rates.
RESULTS: The mean risk- and reliability-adjusted all-hospital readmission rate was 13.2% (SD 1.5%) and mean same-hospital readmission rate was 8.4% (SD 1.1%). Depending on the operation, between 57% (colectomy) and 63% (CABG) of hospitals were reclassified when profiling was based on same-hospital readmission rates instead of on all-hospital readmission rates. This was particularly pronounced in the middle 3 quintiles, where 66% to 73% of hospitals were reclassified.
CONCLUSIONS: In evaluating hospital profiling under Medicare's Hospital Readmissions Reduction Program, same-hospital rates provide unstable estimates of all-hospital readmission rates. To better anticipate penalties, hospitals require novel approaches for accurately tracking the totality of their postoperative readmissions.
Author List
Gonzalez AA, Shih T, Dimick JB, Ghaferi AAAuthor
Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Female
Follow-Up Studies
Health Status Disparities
Healthcare Disparities
Hospitals
Humans
Male
Medicare
Patient Readmission
Program Evaluation
Retrospective Studies
Surgical Procedures, Operative
Time Factors
United States
