How important is it to identify avoidable hospital readmissions with certainty?

Goldfield, Norbert

doi:10.1503/cmaj.110448

Cited by 11 publications

(10 citation statements)

References 3 publications

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“…Figure 3 summarises the numbers and percentages of readmissions assigned to each category, and table 1 gives estimates of the percentage of readmissions in each category subject to mandatory non-payment based on English NHS guidelines. 24 Overall, 17% of emergency readmissions within 30 days would be included in the ‘no payment’ scheme, but there was substantial variation between categories. The most penalised category was A1 (potentially preventable—probable suboptimal care, 49% non-payment), and the least penalised was B2 (unstable deterioration, 9%).…”

Section: Resultsmentioning

confidence: 99%

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Classifying emergency 30-day readmissions in England using routine hospital data 2004–2010: what is the scope for reduction?

et al. 2014

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BackgroundMany health systems across the globe have introduced arrangements to deny payment for patients readmitted to hospital as an emergency. The purpose of this study was to develop an exploratory categorisation based on likely causes of readmission, and then to assess the prevalence of these different types.MethodsRetrospective analysis of 82 million routinely collected National Health Service hospital records in England (2004–2010) was undertaken using anonymised linkage of records at person-level. Numbers of 30-day readmissions were calculated. Exploratory categorisation of readmissions was applied using simple rules relating to International Classification of Diseases (ICD) diagnostic codes for both admission and readmission.ResultsThere were 5 804 472 emergency 30-day readmissions over a 6-year period, equivalent to 7.0% of hospital discharges. Readmissions were grouped into hierarchically exclusive categories: potentially preventable readmission (1 739 519 (30.0% of readmissions)); anticipated but unpredictable readmission (patients with chronic disease or likely to need long-term care; 1 141 987 (19.7%)); preference-related readmission (53 718 (0.9%)); artefact of data collection (16 062 (0.3%)); readmission as a result of accident, coincidence or related to a different body system (1 101 818 (19.0%)); broadly related readmission (readmission related to the same body system (1 751 368 (30.2%)).ConclusionsIn this exploratory categorisation, a large minority of emergency readmissions (eg, those that are potentially preventable or due to data artefacts) fell into groups potentially amenable to immediate reduction. For other categories, a hospital's ability to reduce emergency readmission is less clear. Reduction strategies and payment incentives must be carefully tailored to achieve stated aims.

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Section: Resultsmentioning

confidence: 99%

“…We were deliberately cautious in our terminology—particularly with regard to preventability—as this is a much debated area in the literature. 24 25 …”

Section: Discussionmentioning

confidence: 99%

Classifying emergency 30-day readmissions in England using routine hospital data 2004–2010: what is the scope for reduction?

et al. 2014

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“…Studies show hospital readmissions not only occur due to clinical reasons. Lack of coordination and communication within the health care system itself also plays a big role [10].…”

Section: Identification Of the Problemmentioning

confidence: 99%

“…With the penalty metric accounting for socioeconomic factors, CMS will have a reduction in the hospital penalties collected [36]. Through the decrease in penalty collection and an increase in Medicare beneficiaries, CMS may have to charge higher Medicare premiums or provide less benefits to the beneficiaries [37][38][39][40][41][42][43][44][45][46][47][48].…”

Section: Section 3025 Losersmentioning

confidence: 99%

Reassessing Post-Hospital Conditions of Section 3025 Hospital Readmissions Reduction Program in the Affordable Care Act

Puckett¹

2017

MOJPH

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The Patient Protection and Affordability Care Act (PPACA) brought many changes to the delivery of the U.S. Health Care System since its inauguration on March 23rd, 2010 (Medicare & Services, 2013a). A change within the Affordable Care Act (ACA) is Title III, part III, Section 3025 policy, adopted in 2012. This policy implemented the Hospital Readmissions Reduction Program (HRRP) requiring the Centers for Medicare and Medicaid Services (CMS) to reduce payments to hospitals with higher than expected 30-day readmission rate for acute myocardial infarction, heart failure, and pneumonia. Hospitals with higher-than-predicted readmission rates have their total Medicare reimbursement for fiscal year reduced by up to three percent based on these calculations. This paper reviews the policy in detail and proposes changes that need to be made to the policy to avoid penalizing hospitals unnecessarily.

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“…First, although the research on post-discharge interventions to reduce readmissions remains underdeveloped (Hansen et al 2011), at least three post-discharge interventions have been shown to be effective in clinical trial settings, with absolute reductions in readmissions or post-discharge emergency department use in the 5-10% range (Coleman et al 2006;Jack et al 2009;Naylor et al 1999). Second, the variability in risk-adjusted readmission rates between institutions and regions strongly suggests that some readmissions are preventable (Goldfield 2011, Epstein et al 2011.…”

Section: Preventability Of Readmissions and Other Post-discharge Advementioning

confidence: 99%

Toward Safer Transitions: How Can We Reduce Post-Discharge Adverse Events?

Dhalla¹,

O’Brien²,

Ko³

et al. 2012

hcq

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How important is it to identify avoidable hospital readmissions with certainty?

Cited by 11 publications

References 3 publications

Classifying emergency 30-day readmissions in England using routine hospital data 2004–2010: what is the scope for reduction?

Classifying emergency 30-day readmissions in England using routine hospital data 2004–2010: what is the scope for reduction?

Reassessing Post-Hospital Conditions of Section 3025 Hospital Readmissions Reduction Program in the Affordable Care Act

Toward Safer Transitions: How Can We Reduce Post-Discharge Adverse Events?

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