Weak Link Found Between Readmissions, Mortality

"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," Gorodeski wrote.

But after studying Medicare fee-for-service beneficiaries admitted between July 1, 2005 and June 30, 2008 for treatment of congestive heart failure, pneumonia or heart attack, Krumholz and colleagues concluded that 30-day readmission rates "were not associated" with mortality rates for patients admitted for heart attack or pneumonia, and were "only weakly associated within a certain range" for patients admitted for heart failure.

"We show that hospitals can do well on both measures, with many hospitals having low risk-standardized mortality rates and risk-standardized readmission rates," Krumholz wrote.

Concerns have been raised for two other reasons. First, the Centers for Medicare & Medicaid Services' rules assess financial penalties of up to 3% for hospital with higher rates of readmissions, but punish hospitals with higher mortality by withholding incentive pay amounting to a maximum of only 25% of 1.25% in incentive payment, starting this October.