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Health Systems

Modest Proposal: A New Report Card for Rating Hospitals

UTSW research says the current system may be missing the mark.

To reduce hospital costs for the nation’s seniors and at-risk, the Centers for Medicare and Medicaid Services (CMS) penalizes hospitals if their patients are readmitted after a hospitalization. CMS incentivizes hospitals to get patients out of the hospitals and to recover at home. Readmissions negatively affect hospital ratings.

But researchers at UT Southwestern took a harder look at how these hospitals are rated and published a study that supports a new way to evaluate hospitals. While patients may leave the hospital, they often end up in skilled nursing, rehabilitation, or other long term care facilities. This means that they still require costly care on the taxpayers’ dime, but the hospital is not punished unless they return to the hospital. In 2019, CMS penalized nearly 2,600 U.S. hospitals and withheld an estimated $563 million in Medicare payments because the hospitals exceeded the expected number of patient readmissions. 

That means a hospital whose patients are out of surgery and recovering quickly at home are evaluated in a similar way to a hospital whose patients spend months in a rehab facility or with nursing aides, adding costs to Medicare. The researchers, Dr. Ambarish Pandey and Dr. Neil Keshvani, have developed a new way to evaluate hospitals that consider full recovery. 

Pandey and Keshvani propose that Medicare look at the number of days a patient spends at home after discharge to ensure that hospitals aren’t pushing patients out the door who may need significant nursing care, or have died. The proposed metric measures how many of the 30 days following hospitalization are spent at home, or as they call it, the “risk-adjusted 30-day home time” test, as opposed to the current 30-day measure that only measures if a patient returns to the hospital. 

The study says that the new metric complements the original 30-day readmission metric “by not only accounting for post-discharge mortality but also the variability in the post-acute care utilization of intermediate/long-term care facility and [skilled nursing facilities]. A home time metric may be more easily understood by patients and clinicians.” 

The study found that 30 percent of the time, the new metric changed the quality ranking that a hospital received under the standard readmission measure. Right now, CMS only punishes hospitals if they return to the hospital within 30 days, but that patient may not be at home or could even be dead. CMS wants patients at home for their comfort and the sustainability of the system.

“The current readmission penalty has been a matter of debate,” Pandey, an assistant professor of internal medicine at UT Southwestern, said via release. “Some hospitals that have had lower readmission rates were actually having high mortality rates. If you die, you’re not going to be readmitted.” 

The researchers hope to attract attention from policymakers who can adjust the way hospitals are evaluated. “CMS is working toward making metric to be more patient-centric,” Pandey says. “The existing, hospital-oriented approach is good for the hospitals, but this is a more patient-centric metric. Patient care is not just about the hospital.”

Hospitals that scored well on the 30-day home time metric were more likely to be academic medical centers. The study was published in JAMA Cardiology as well as Circulation. 

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