30-Day Readmissions Rule Under Two-Pronged Attack

Five months before Medicare's hospital readmission penalties take effect, two groups of authors say Congress and the government are taking the wrong approach.

Although the authors make different points, each says that the regulation, embedded in the Affordable Care Act, won't accomplish its intent. Both are published in Perspectives in Thursday's New England Journal of Medicine.

"Policymakers' emphasis on 30-day readmissions is misguided for three reasons," says one article "Thirty-Day Readmissions—Truth or Consequences," by Karen Joynt, MD, and Ashish Jha, MD, of the Harvard School of Public Health.

1. Preventability. Only a small portion of readmissions up to 30 days after discharge are preventable, patient and community factors—like poor mental health or poor social support and poverty—drive much of what impacts readmissions and high rates of readmissions may in fact mean better quality of care.
2. There are better policies to effect lower readmissions.
3. Hospitals may spend energy on reducing readmissions at the expense of efforts to improve patient safety and other quality improvement projects.

Finally, Joynt and Jha wrote, very few of the millions of readmissions being targeted are actually preventable, ranging from at best 59%, but more realistically 12% when clinical data was obtained.