The Issue
Because of provisions in the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) will be targeting avoidable hospital readmissions to improve quality and reduce Medicare spending. However, measures of quality that capture all-cause 30-day readmission rates may also include instances of planned readmissions, such as those for chemotherapy treatments. Hospitals and clinicians are likely to argue that counting such readmissions among other potentially avoidable readmissions is inconsistent with high-quality clinical practice.
What the Study Found
This commentary, supported by The Commonwealth Fund, explores the problems CMS may encounter in trying to exclude certain criteria from the readmissions measure. Difficulties may include potentially complex coding mechanisms, questionable reliability of Medicare claims data, and the challenge of developing a consensus within the provider community on a common set of excludable codes, among others. The authors suggest an alternative: creating a planned readmission code that could be used prospectively to indicate a planned procedure.
Conclusions
A planned readmission code could provide a reliable method for excluding many planned hospital readmissions from measurement by CMS and help ensure that hospitals and physicians can practice evidence-based care without penalty.