Medicare's use of administrative claims data is an unfair way to identify hospitals with unusually high readmission rates following surgical procedures, according to a new study in JAMA Surgery.
Researchers reviewed 315 consecutive patients discharged following general surgery procedures over a 2-year period. They compared the reasons for readmission within 30 days of discharge noted in medical records with administrative diagnoses recorded in the medical center's claims database — the information Medicare would review to measure all-cause readmission rates and levy financial penalties on hospitals with rates that were higher than expected.
According to the findings, the reasons for readmission differed between clinical diagnosis and claims data in about one-third of the cases. Additionally, the claims data identified only 5% of readmissions as planned when the medical records indicated nearly 14% were expected. The clinical data also showed about one-fourth of the unplanned readmissions were for reasons unrelated to the original surgeries.
"Administrative billing data, as used by the readmission measure, do not reliably describe the reason for readmission," wrote the researchers.
In an accompanying editorial, David R. Urbach, MD, MSc, of the division of general surgery at the University of Toronto in Canada, points out that at least 8% of surgical patients required re-hospitalization within a month, and wondered how many readmissions are preventable.
"Although discharge interventions can reduce readmission rates, so too can increasing the length of a hospital stay, creating an incentive for hospitals to trade off efficiency to avoid readmission-related penalties," he wrote. "Surgical care is highly nuanced, and surgeons need to be engaged in this process."