Avoiding readmissions is a critical component of every recent healthcare payment initiative. Current Medicare payment rules penalize hospitals with high readmission rates, the Bundled Payment Initiative requires contracting organizations to include related readmissions in the payment bundle, and ACOs will have incentives to reduce readmissions to create “shared savings”.
All of these assume that readmissions can be reduced or eliminated, based on information available to the hospital and physicians at time of discharge. But can they? In his Disease Management Care blog, physician Jaan Sidorov describes a NEJM study ("Risk Prediction Models for Hospital Readmission") suggesting that the currently-available methods for predicting readmissions have about the same predictive ability as a coin-flip. This follows another recent Canadian Medical Association Journal article (“Incidence of potentially avoidable urgent readmissions and their relation to all-cause urgent readmissions”) that suggests that about 80% of readmissions are unpredictable and therefore unavoidable.
If this is true, hospitals and contracting organizations are increasingly at risk of being penalized for random, uncontrollable events. While is certainly appears to us that some efforts to reduce readmissions (primarily better discharge planning and post-discharge follow-up) should yield significant positive results, statistical evidence may not support this conclusion. The effort is certainly worthwhile, but the results may be disappointing. Organizations involved in these new payment programs should be careful to project realistic financial results about the cost-effectiveness of their efforts to reduce readmissions.