Three studies recently published have indicated that the solution to lowering readmission rates might be more complex than many had imagined. While researchers indicated a startling number of patients are presenting to the emergency department (ED) within 30-days of their initial hospitalization, these ED visits may be seen as less severe if they do not result in a hospitalization. However, the incentive to shift care to the ED should not be viewed as a sustainable solution.
Echoing the findings of the JAMA studies, a report in the Annals of Emergency Medicine reinforces the notion that hospitals are ignoring the “significance” of ED visits by discharged hospital inpatients. “By limiting the focus of hospital readmissions measurement to only inpatient-to-inpatient events and omitting ED visits shortly after hospital discharge, researchers and policymakers may be missing a substantial source of return-to-acute health care use that is managed solely in the ED,” the study reports.
The emphasis the Centers for Medicare & Medicaid Services (CMS) have placed on reducing readmission rates has left hospitals struggling to meet CMS guidelines. Critics are questioning whether it is fair to make hospitals responsible for a metric like readmission that makes hospitals accountable for the personal lives of discharged patients. These critics point out that hospitals with higher mortality rates also have fewer patients being readmitted, and thus a hospital’s readmission rate is not a metric that is indicative of quality care.
In a recent article in the New England Journal of Medicine, Karen Joynt, MD, MPH, states, "the latest data also make(s) it clear that the (Hospital Readmission Reduction Program) HRRP will penalize hospitals that care for the sickest and the poorest Americans, largely because readmissions are driven by the severity of underlying illness and social instability at home". In the article Joynt points out that there are simple changes that could improve care coordination without hurting the hospitals that are caring for the most vulnerable patients. She proposes giving hospitals credit for low mortality rates, adjusting readmission rates for socioeconomic status, and “weighting the HRRP’s penalties according to the timing of readmissions.” Joynt explains that a readmission that occurs a few days after discharge may be an indication of poor care, whereas a readmission 4 weeks later is more likely to be due to “the underlying severity of a patient’s disease.”