Obamacare: Why penalize for readmissions instead of mortality rates?

[beachbum87]

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So here's an interesting article.

http://www.kaiserhealthnews.org/Sto...gmr_58088.gde_58088_member_147165116Basically 2/3rds of the hospitals in America are getting fined because their readmission rates are too high. But here's an interesting twist.

"A lot of places have put in a lot of work and not seen improvement," said Dr. Kenneth Sands, senior vice president for quality at Beth Israel. "It is not completely understood what goes into an institution having a high readmission rate and what goes into improving" it.
Sands noted that Beth Israel, like several other hospitals with high readmission rates, also has unusually low mortality rates for its patients, which he says may reflect that the hospital does a good job at swiftly getting ailing patients back and preventing deaths."

http://www.kaiserhealthnews.org/~/media/Files/2012/Medicare%20Readmissions%20Penalties%202013.pdf

So why did Obamacare choose to fine everyone for readmission rates without taking into account other things like mortality rate.



By the way Mass Gen was fined .5%, New York Presbyterian .7%, Beth Israel 1%

 

[ShenanigansMD]

Limiting readmissions saves money (e.g., unnecessary surgeries), but mortality rates should be considered as well. Both of these are affected by the population that is being served, so they are really tough to improve upon in some places.

 

[Praefectus]

Limiting readmissions saves money (e.g., unnecessary surgeries), but mortality rates should be considered as well. Both of these are affected by the population that is being served, so they are really tough to improve upon in some places.

👍 Academic hospitals would probably have a higher mortality rate because they take the harder/rarer cases. Unfortunately, this is what happens when bureaucrats are put in charge of medicine.

 

[Bangersandmash]

👍 Academic hospitals would probably have a higher mortality rate because they take the harder/rarer cases. Unfortunately, this is what happens when bureaucrats are put in charge of medicine.

Superfreakonomics addressed this issue. They wanted to see if the best doctors really had the best results and their methodology concluded that doctors shouldn't be judged on their mortality rates because the best ones often take the hardest cases and see the most mortality.

I don't think mortality rates would be a really good measure of hospital performance. I think preventable mistakes would the best way to really judge how a hospital is performing. Readmissions and mortality rely somewhat on patient behavior. Preventable mistakes (like mainline IV infections, surgical mistakes, improper medication dosage) is all on the hospital.

 

[MedPR]

Superfreakonomics addressed this issue. They wanted to see if the best doctors really had the best results and their methodology concluded that doctors shouldn't be judged on their mortality rates because the best ones often take the hardest cases and see the most mortality.

I don't think mortality rates would be a really good measure of hospital performance. I think preventable mistakes would the best way to really judge how a hospital is performing. Readmissions and mortality rely somewhat on patient behavior. Preventable mistakes (like mainline IV infections, surgical mistakes, improper medication dosage) is all on the hospital.

+1. Not only the best doctors, but also the best hospitals in general.

 

[matchb0x]

Simple: readmission cost Gov mo' money. Mortality saves Gov money cuz you dead. Word.

 

[MedPR]

Simple: readmission cost Gov mo' money. Mortality saves Gov money cuz you dead. Word.

🤣

 

[Gut Shot]

So why did Obamacare choose to fine everyone for readmission rates without taking into account other things like mortality rate.

Readmission rates have been in the crosshairs since well before Obamacare. Here is an example of an article that was published in 2008 and explains some of the underlying rationale.

 

[calvnandhobbs68]

Simple: readmission cost Gov mo' money. Mortality saves Gov money cuz you dead. Word.

Love it.

Quality measures are an intensely debated subject and there are arguments supporting almost any type of quality measure people have tried to quantify. We're basically going to see how a lot of these play out over the next few years and which ones are most applicable/achievable on a national scale.