Jan. 6—First-time Medicare data showed that 364 hospitals, including some of the highest-profile facilities, had higher-than-average overall readmissions, according to an analysis.

A Kaiser Health News analysis of Medicare data on hospitalwide all-cause unplanned readmissions, which were released for the first time in December, showed 8 percent of hospitals readmitted patients more frequently than other hospitals, regardless of condition. Such facilities included nationally recognized hospitals, including the Cleveland Clinic.

The analysis also found 315 hospitals, or 7 percent of those rated by Medicare, had lower-than-average readmission rates. The better-performing hospitals included Intermountain Medical Center in Utah and Mayo Clinic Hospital, Phoenix.

The latest rates of readmissions within 30 days of discharge are an expansion of rates Medicare began reporting in 2008. Medicare penalizes hospitals for readmissions related to heart failure, heart attack, and pneumonia. The most recent round of penalties hit 2,225 hospitals.

The all-cause readmissions measure is significant because the Medicare Payment Advisory Commission (MedPAC), which is Congress’ primary advisory body on the program, has considered giving the new readmissions measure a bigger role

"This is a metric providers should pay attention to," said Chad Mulvany, director of healthcare finance policy, strategy, and development for HFMA. "MedPAC has often discussed the need to move to a global readmissions metric to address some of the challenges it sees with condition-specific measures."

A move toward an all-cause readmissions model would reduce the impact of random variation on smaller hospitals, according to MedPAC, which may have relatively few specific types of cases on which the base readmission rates.

Some hospitals have raised concerns that a move to an all-cause readmission penalty could unfairly affect those that treat higher proportions of low income patients, such as academic medical centers, since those patients may be less likely to adhere to treatments and require more readmissions.

Publication Date: Monday, January 06, 2014