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Higher Readmission Penalties Linked to Low HCAHPS Scores

Cheryl Clark, for HealthLeaders Media, December 12, 2012

Ryan and Buhlman say the Press Ganey analysis, which they presented at the Institute for Healthcare Reform's 24th National Forum in Orlando this week, is the first time anyone has found a correlation between readmission penalties—the first of which kicked in with discharges Oct. 1, affecting up to 1% of Medicare DRG payments—and patient experience.

Press Ganey, which also consults with hospitals to improve patient experience scores, reviewed data for the two performance periods that CMS uses to determine value-based purchasing incentive payments and readmission penalties. For readmissions, Press Ganey used the rate of observed readmission from July 1, 2008 to June 30, 2011. 

For the value-based purchasing HCAHPS score performance, the company used the performance period from July 1, 2011 to March, 31, 2012, and used the points the hospital earned for performance compared with a baseline performance period, from July 1, 2009 to March 31, 2010.

The association between scores was only found with respect to HCAHPS, which is only 30% of the value-based purchasing score.  There was no correlation between readmission penalties and how the hospitals performed on the other 12 core clinical measures that make up 70% of the VBP incentive payment program.

That's probably because for most hospitals, performance on those core measures is already at 97, 98, 99 or 100%, "almost as good as you're going to get," Buhlman says.

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2 comments on "Higher Readmission Penalties Linked to Low HCAHPS Scores"


Michael Solomon, Ph.D. (1/24/2013 at 3:57 PM)
Recognizing that patient satisfaction may be a factor in helping patients avoid returning to the hospital is a good starting point, but the emphasis on HCAHPS diverts attention from the more important goal of having patients who are actively engaged in managing their health and healthcare post-discharge. Providing a patient with a discharge summary and education materials about his or her condition and helping a patient comply with having a physician exam post-discharge are practices shown to be related with reduced readmissions. Except for the patient-provider communications item, the HCAHPS does not measure these important indicators of actively engaged patients. Programs to reduce preventable readmissions should move beyond satisfied to actively engaged patients. A reliable and valid measure of patient activation, known as the PAM-13 exists. Interventions such as web-based self-management tools have been shown to increase patient activation.

Steve Wilkins (12/13/2012 at 11:37 AM)
Correlation is not the same as causality. The conclusions drawn linking patient experience (as nebulously defined by HCAHPS) to reduced hospital readmissions sure seems like a big reach to me. Steve Wilkins, MPH Mind the Gap www.healthecommunications.wordpress.com