Hospital 30-day, all-cause, risk standardized readmission rate following acute MI hospitalization
The measure estimates a hospital-level 30-day risk-standardized readmission rate for patients discharged from the hospital with a principal diagnosis of acute MI. The outcome is defined as unplanned readmission for any cause within 30 days of the discharge date for the index admission. A specified set of planned readmissions do not count as readmissions. The target population is patients aged 18 years and older. CMS annually reports the measure for individuals who are 65 years and older and are either Medicare FFS beneficiaries hospitalized in non-federal hospitals or patients hospitalized in Department of VA facilities
ACP does not support this measure because it is not appropriately risk-adjusted. Recent literature identifies a set of patient characteristics for risk-adjustment that are significantly more robust than the characteristics currently used by CMS. The paper presented data indicating that the range in readmission rates (around 5%) between hospitals in the lowest quartile and hospitals in the highest quartile is cut in half when additional patient characteristics are included. ACP acknowledges that readmission rates are not entirely independent of provider control; however, NQF #0505 employs a measurement period (30 days) that is more likely to be influenced by outside factors than a shorter interval, such as 7 days. Furthermore, this measure could have immediate financial impact on hospitals, and without accurate risk-adjustment, patient populations that need more care are going to be penalized. Targeting readmission rates would require significant resources to make minimal impact, but the hospitals that need the most impact have the most limited resources.