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Hospital Readmissions, Mortality Incentives Alarmingly Misaligned

Cheryl Clark, for HealthLeaders Media, April 26, 2012

Of course we want to keep patients out of the hospital by managing their care better in the hospital. Readmissions aren't always good for patients, and they cost the Medicare program tons of money. Better to keep them healthy outside.

Misaligned incentives
But Joynt and Jha make an excellent point about the misalignment of incentives under the Affordable Care Act, which the Centers for Medicare & Medicaid Services may not be able to significantly change without an act of Congress. The ACA, for example, requires that measures related to surgeries, patient experience scores, and efficiency of care be factored into the equation, and the amount of the penalty is statutorily set.

However, the Health and Human Services Secretary is allowed to assign the weight for the ingredients in that formula as she "determines appropriate."

I'm not sure why the ACA was cobbled this way. It may be that policymakers aren't sure that hospital mortality can be as fairly risk-adjusted as hospital readmissions. Perhaps it was because of the huge amount of money that avoidable readmissions cost taxpayers.

Many recent columns in this space have focused on improving the readmissions effort, and that of course should remain an important hospital goal. But Jha's and Joynt's point about these misaligned financial penalties, and their potential consequences, asks a thought-provoking question, and provides a critical alert.

See Also:
30-Day Readmissions Rule Under Two-Pronged Attack
Keeping Readmission Rates Low with Treatment Guidelines


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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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.