Hospital Readmissions, Mortality Incentives Alarmingly Misaligned
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.
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.