Medicare Quality Measures May Fall Short

Condition-specific readmissions measures for heart failure, pneumonia, and heart attack may not accurately or fairly reflect hospital quality.

Condition-specific readmissions measures for heart failure, pneumonia, and heart attack may not accurately or fairly reflect hospital quality, according to a study published this week in the Annals of Internal Medicine.

The study found significant differences in hospitals' performance when readmissions were assessed for non-Medicare patients and for conditions other than those currently reported, showing that when these additional factors are taken into account, half of the hospitals would be subject to a change in their financial penalty status.

The Hospital Readmissions Reduction Program (HRRP), a national mandatory penalty-for-performance program, was unveiled by CMS with the passage of the Affordable Care Act. Although the HRRP has worked to drive down readmission rates, CMS recently hit 2600 hospitals with penalties for failing to hit targets. Hospital leaders have long been concerned about the size of the penalties and the lack of adjustment for socioeconomic and clinical factors.

Calculations known as excess readmission ratios (ERRs) examine hospitals' readmissions for heart failure, heart attack, and pneumonia among Medicare beneficiaries. These ERRs are currently used to assess care quality in the form of consumer report cards and to determine the financial implications for hospitals.

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