Study identifies pitfalls in current calculation of hospital readmission rates in spine surgery

Published on October 12, 2012 at 4:33 AM · No Comments

When hospital patients have to be readmitted soon after discharge, hospitals look bad.

And in addition to reflecting poorly on a hospital's quality of care, a high readmission rate also can result in reduced Medicare reimbursements, under provisions now taking effect under the 2010 health care law.

But a study of spine surgery patients has found that the standard method used to calculate readmission rates is a misleading indicator of hospital quality. Loyola University Medical Center neurosurgeon Beejal Amin, MD, and colleagues found that 25 percent of the readmissions of spine surgery patients were not due to true quality-of-care issues.

Amin presented findings Oct. 10 at the 2012 meeting of the Congress of Neurological Surgeons in Chicago. He earlier presented findings at the 2012 meeting of the American Association of Neurological Surgeons.

"We have identified potential pitfalls in the current calculation of readmission rates," Amin said. "We are working on modifying the algorithm to make it more clinically relevant."

Medicare is trying to improve patient care by penalizing hospitals with poor outcomes. One key outcomes measure is the readmissions rate. On Oct. 1, Medicare began fining hospitals that have too many patients readmitted within 30 days.

In spine surgery, a high readmission rate can indeed reflect poorly on a hospital's quality of care if the readmissions are due to reasons such as infections, surgical complications, blood clots and failures of surgical hardware, Amin said.

But some types of readmissions are not a true indication of quality of care, Amin said. Such cases include:
-- Planned readmission for a staged procedure. For example, a procedure to straighten a curved spine in a scoliosis patient requires two surgeries performed about 15 days apart.
-- Readmission unrelated to spine surgery. Occasionally, patients who undergo spine surgery will be readmitted within 30 days for surgery for an unrelated condition, such as a hip replacement.
--Operation cancelled or rescheduled for unpreventable reasons. For example, a patient is admitted to the hospital but the spinal surgery is postponed due to an irregular heart rate. The patient is readmitted a couple weeks later for elective surgery, after the heart rhythm is controlled.

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