No easy answers to the riddle of readmissions

March 18th, 2015

Is there a mercy rule when it comes to academic research? Should there be?

In some youth sports leagues, the mercy rule kicks in and ends the game once the score has become sufficiently lopsided that it’s clear the losing team has no hope of mounting a comeback. I’m not sure exactly where the score stands now regarding research on reducing 30-day readmissions, but I have an inkling that it might be time for the refs to step in.

Just yesterday, JAMA Surgery ran a study in which “[n]o significant variation was found in hospital readmission rates after colorectal cancer surgery when the data was adjusted to account for patient characteristics, coexisting illnesses and operation types, which may prompt questions about the use of readmission rates as a measure of hospital quality,” according to a news release from JAMA Network.

And a week before that, a study in JAMA itself found that “[a]mong fee-for-service Medicare beneficiaries discharged to a SNF after an acute care hospitalization, available performance measures were not consistently associated with differences in the adjusted risk of readmission or death,” according to the study’s abstract.

So we’re in a situation where more than 2,600 hospitals are being penalized to some extent because of their readmission rate, despite the increasing clarity of the fact that there is no quick fix, no easy answer, no “one weird trick” to reduce that rate in a fair, safe, systematic way. It’s true that nationally the Medicare readmission rate has declined a bit recently, as Jill Drachenberg noted recently on this blog. But it troubles me that we still don’t have a clear picture of why. And at the level of public policy, it seems unfair to penalize hospitals for a problem no one seems to know definitively how to fix.