Hospital 30-Day, all-cause, risk standardized readmission rate following heart failure hospitalization
The measure estimates a hospital-level risk-standardized readmission rate (RSRR) for patients discharged from the hospital with a principal diagnosis of heart failure (HF). 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 18 and over. CMS annually reports the measure for patients who are 65 years or older and are either enrolled in fee-for-service (FFS) Medicare and hospitalized in non-federal hospitals or are hospitalized in Veterans Health Administration (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 #0330 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.