HLM: What can be done to restore 30-day readmissions as an accurate metric for value-based, care coordination?
Fonarow: There are a number of measures where you can look at the processes that have been associated with outcomes, and also directly measure patients’ health status as well as, most critically, patient survival. They can be integrated into a multi-dimensional component of assessment and still incentivize that kind of quality of care and moving beyond the hospital walls and investing in heart failure disease management programs that have been shown to improve all components of care and outcomes.
HLM: What should be done with the study?
Fonarow: I would like to see immediate action taken by Medicare to convene a multi-stakeholder panel to discuss steps forward to try and modify the program, suspend it with regards to heart failure patients, and develop proactive steps to mitigate it and better understand lessons learned and how these kinds of unintended consequences can be avoided in the future.
HLM: How did this metric morph into its evil twin?
Fonarow: You can say it did reduce readmissions. It didn’t backfire that way, but it backfired in a far more disastrous way.
It’s why it’s so important, just as we not unleash a new therapy on patients without having tested it, it’s critical to recognize that policy decisions can have disastrous side effects. Major policies should be pilot tested. There needs to be proactive close monitoring for any unintended consequences.
This was unleashed with no monitoring. Here we are talking about data that took a few years to assemble, but as early as 2013-14 there was a clear increase in mortality that we are just finding out about. Now that this data has come to light, it’s critical that we act.
John Commins is a senior editor at HealthLeaders.