One after another, the “next new ideas” in healthcare seem to be failing. This time it’s the potential to reduce readmissions that the New England Journal of Medicine takes to task. Despite CMS’s focus on incentivizing hospitals to reduce their readmission rates (by including them in bundled payment budgets) and penalizing those hospitals with higher-than-average rates, the NEJM finds that readmissions within 30 days are largely not preventable. Most of the causes of these readmissions are “patient and community-level factors that are well outside of the hospital’s control”, and higher readmission rates may not correlate with other measures of quality such as mortality rates. (Interestingly, other commonly-used quality measures apparently don’t correlate with mortality either, but that’s a topic for another blog post.) And the authors comment that programs to reduce readmissions, while ultimately proving to be unsuccessful, may redirect hospital efforts away from more promising and important initiatives such as improving patient safety. NEJM has previously reported on this topic, so it appears that they have an abundance of information and research.
We see two takeaways from this and other similar articles. First, despite evidence to the contrary, Medicare and other payers are unlikely to change their strategies regarding reducing payments for readmissions. In fact, the lack of ability to reduce readmissions makes this strategy more successful for the payers: payers reduce payment for readmissions; hospitals can’t reduce readmissions; therefore the payers pay less. Hospitals should resist these payment arrangements to the extent that they can; however this is probably a lost cause.
Second, hospitals should cast a critical eye towards the promising but unproven management processes that purport to improve quality and/or improve costs but have not demonstrated success at achieving either goal. Recent research debunking the effectiveness of pay-for-performance programs in reducing mortality, the effectiveness of EHR systems in reducing diagnostic testing, and the overall lack of effectiveness of many of CMS’ quality improvement and cost reduction demonstrations has shown that significant time and effort can be spent in following the latest healthcare trends. Healthcare leaders should be heading where the evidence leads, not down the path of the “next great idea”.