Study: Readmissions Not Tied To Surgery Errors
By Christine Kern, contributing writer
The study’s findings might redefine how healthcare providers view their approach to reducing readmission rates.
A study from Northwestern Medicine and the American College of Surgeons published by JAMA suggests pay-for-performance policy initiatives should focus on reducing surgical complications, not readmissions. Northwestern Medicine writes the study posits that penalizing hospitals for patient readmissions following surgery is at best ineffective and could even prove to be counterproductive to improving the quality of care in hospitals in the United States.
The study – Underlying Reasons Associated With Hospital Readmission Following Surgery in the United States – finds, “Readmissions after surgery were associated with new post-discharge complications related to the procedure and not exacerbation of prior index hospitalization complications, suggesting that readmissions after surgery are a measure of post-discharge complications. These data should be considered when developing quality indicators and any policies penalizing hospitals for surgical complications.”
According to the study, most surgical readmissions are not due to poor care coordination or mismanagement of known issues, but rather were the result of expected surgical complications such as wound infections that occurred after discharge and were not present during a patient's hospital stay more than 97 percent of the time.
These findings could radically alter the way hospitals have been attempting to reduce readmission rates. Hospitals have been focusing a lot of attention on how to improve quality of patient care and outcomes, including a mandated reduction in readmission rates. As Health IT Outcomes reports, readmission rates can differ by disease and insurance carrier as a report from the Agency for Healthcare Research and Quality found.
Currently, unplanned patient readmission rates – including surgical patients – is currently tracked and publicly reported by the Centers for Medicare & Medicaid Services (CMS). CMS also has the power to reduce a hospital’s reimbursement if it determines the hospital has too many readmissions within a period of 30 days following a patient’s discharge for certain care, under the Readmissions Reduction Program.
“There has been a growing focus on reducing hospital readmissions from policymakers in recent years, including readmissions after surgery,” said lead author Karl Y. Bilimoria, MD, MS, a surgical oncologist and vice chair for quality at Northwestern Memorial Hospital, and director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine. “But before this study, we didn’t really understand the underlying reasons why patients were being readmitted to hospitals following surgery.”
“These results clearly demonstrate that the vast majority of complications that cause readmissions are not due to a lack of coordination or complications that occurred during the initial hospitalizations,” said Bilimoria. “These complications were new and occurred after the patients were discharged and were recovering at home.
“Many of the issues that were identified can help hospitals better focus their efforts to continue to reduce potential readmissions. Our results also highlighted that many of the complications involved in readmissions, such as surgical-site infections, are already well-know and part of other CMS pay-for-performance programs, which means hospitals are effectively being penalized twice for the same complications.”