Data Dives

When Going Back To The Hospital Is Good News

By Jordan Rau

July 24th, 2012, 11:42 AM

No one wants to be readmitted to a hospital, but it does beat one alternative: death. As Medicare prepares to start punishing hospitals with higher than expected readmission rates, new government data show that some hospitals with high readmissions are actually doing a better job than most in keeping Medicare  patients alive.

Beth Israel Deaconess Medical Center in Boston and Olympia Medical Center in Los Angeles both had higher than average readmission rates for all three conditions that Medicare tracks publicly: heart attack, heart failure and pneumonia. But Beth Israel and Olympia also had lower rates of mortality within 30 days of discharge for patients with all three of these conditions, according to the latest data published last week on Medicare’s Hospital Compare website.

In addition to Beth Israel and Olympia, three other hospitals had unusually high readmission rates for heart attack but lower than average mortality rates: Maimonides Medical Center in Brooklyn, N.Y.; Henry Ford Hospital in Detroit; and North Shore University Hospital in Manhasset, N.Y.

Thirty-one hospitals besides Beth Israel and Olympia had low mortality for heart failure patients even as they had high readmission rates. And 14 hospitals besides Beth Israel and Olympia had low mortality for pneumonia patients even as they had high pneumonia readmission rates.

To be sure, these hospitals are a small portion of the nation’s 4,000 acute care hospitals. But a number of researchers say this is another reason to be wary of the upcoming financial penalties Medicare plans to enact against hospitals with higher than expected readmissions rates. Researchers at the Cleveland Clinic studied heart failure readmissions and found high rates were associated with lower mortality. In a 2010 letter to the New England Journal of Medicine, the authors wrote:

Our findings suggest that readmissions could be “adversely” affected by a competing risk of death — a patient who dies during the index episode of care can never be readmitted. Hence, if a hospital has a lower mortality rate, then a greater proportion of its discharged patients are eligible for readmission. As such, to some extent, a higher readmission rate may be a consequence of successful care. Furthermore, planned readmissions for procedures or surgery may represent appropriate care that decreases the risk of death, but this is not accounted for in Hospital Compare.

Starting in October 2013, Medicare plans to take mortality rates into account when reimbursing hospitals under its “Value Based Purchasing” program. Mortality rates will initially only count for 25 percent of the bonuses or penalties hospitals will receive, with the rest determined by patient ratings and measures showing how often hospitals followed basic clinical care guidelines.

4 Responses to “When Going Back To The Hospital Is Good News”

  1. Luann P. Sweeney says:

    Maybe that’s the underlying, unspoken intent of this…..if Medicare recipients are dead, they don’t cost anything! But really, there must be some circumstance whereby the 30 day re-admission is warrented and might the question be are these patient being discharged too soon to keep the LOS numbers in line with the budget? Do we have enough room for individual care in our large hospital systems? Maybe there should be more collaboration between inpatient and primary care in deciding discharge of these high risk patient with a “patient-centered” focus on how they realistically can do after discharge, especially to home.

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  3. I think this is a very interesting finding and points to the fact that one should not look at intermediate outcomes but at the final outcomes (mortality) as a measure of quality. Perhaps these hospitals also have better follow up of their patients so that they are readmitted when necessary.

  4. Lisa says:

    Good research, wish more could be done. Everyone has to die sometime- hospitals shouldn’t get “dinged” for the inevitable. We should not be scored on readmissions or mortality. Demographics plays a big role in this area, also. The public also needs to be accountable for their own health. We can’t go home and babysit them. (No matter how much we’d like to…I know many a nurse who’d happily do so…but the cost is too high)