Although the Centers for Medicare and Medicaid Services (CMS) has placed greater emphasis on using readmission rates for determining hospitals’ reimbursements, a study in Health Affairs warns that the measure should not be the only criteria against which hospitals are graded. Comparing 2009 readmission rates against 2011 numbers, researchers found “that whether a hospital's readmission rate went up or down, and to what degree if it did change, is explained in part… by how high or low it was to start. This relationship was due primarily to regression to the mean.” The study did offer policy and analysis solutions to account for the fluctuation.
As Health Affairs warns of relying too much on readmission scores, the reported overall decline in hospital readmission rates might be attributed to the growing use of Observation Units as an alternative to the inpatient department. “Since observational-status patients aren't counted as admissions, they aren't counted as readmissions if those patients are hospitalized within 30 days,” Modern Healthcare reports. Researchers and healthcare providers suggest that patients admitted to Observation Units today would have been admitted to the inpatient department if hospitals were not penalized by CMS due to high readmission rates – a practice that began with the passage of the Affordable Care Act. Thus, any downward trend in readmission rates may not be reflective of a hospital’s ability to improve the quality of care.
In a study published May 3, 2013 in Journal Watch Emergency Medicine, Herring AA et al. report that “critical care in the ED is increasing – it’s not just your imagination.” The team of researchers analyzed data from the National Hospital Ambulatory Medical Care Survey from 2001-2009 and found that critical care increased dramatically during this period. Specially, the numbers they report from this period for annual critical care unit admissions from United States EDs increased by 79%, from 1.2 to 2.2 million. They attibute this being “driven by (the) increasing numbers of critical care ED visits and lengthening ED length of stay.”
Today’s Hospitalist posted a video offering hospitalists’ perspective on their role in post-acute care. Watch it below.