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Hospital Readmissions, Mortality Incentives Alarmingly Misaligned

Cheryl Clark, for HealthLeaders Media, April 26, 2012

"And Beth Israel is a terrific hospital," Jha says. "The more you look, you do see the pattern."

In fact, almost no hospital in the country excels in both readmissions and mortality disease categories.

What Jha fears is that some low mortality hospitals will start realigning their resources in favor of programs that avoid readmissions.

Lopsided incentive system "is frustrating"
I asked Ken Sands, MD, Beth Israel's senior vice president for healthcare quality, if he thinks that will happen. The lopsided incentive system "is frustrating," he tells me. "We're proud of the fact we have a low mortality and we want to do everything possible to decrease preventable readmissions. But we certainly don't want to lessen performance on mortality while doing so."

Sands thinks it's too early to say whether other hospitals will shift any of their focus from life-saving measures. But he acknowledges, "it's certainly true that funds are going to be spent to prevent readmissions, and they have to come from somewhere."

They might come from something that targets patient satisfaction scores, or in resources now spent to improve access to care, he cautions.

In a Perspective article "Thirty-Day Readmissions—Truth and Consequences" in the New England Journal of MedicineApril 12, Jha and Harvard colleague Karen Joynt, MD, elaborated on their concern that hospitals would pull resources away from quality improvements that save lives and shift them to programs that avoid readmissions. Among their points:

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2 comments on "Hospital Readmissions, Mortality Incentives Alarmingly Misaligned"


Carl (4/30/2012 at 10:59 AM)
It makes sense from a financial point of view. If the patient dies, their expenses cease. It is the money with which CMS is concerned. I have noted in my research that the hospitals with the lowest mortality rates also have higher readmission rates.

Michael Barber MD (4/26/2012 at 3:26 PM)
There is significant data and experience that would indicate that reducing readmissions is a good way to reduce 30 day mortality plus it is easier to measure and does not require risk adjustment like mortality. The problem that hospitals, even high quality ones like Beth Israel, see readmissions as the only way to reduce mortality instead of increasing the community based resources that can increase adherence to therapy and solve many of the non clinical problems that contribute to both readmissions as well as premature mortality. Studies of "hospital at home" for congestive heart failure show that treatment costs are 20% less and complication rates nearly zero as well as fewer clinical relapses. Other studies show that primary admissions for these disesases can be reduced up to 50% by taking a highly integrated person centered approach to our most vulnerable elders. In my mind, the financial incentives to use inpatient resources to heal our patients have caused hospital leaders to have blinders on the work that can be done at the community level.