A study from doctors in the departments of neurological surgery and orthopedic surgery at the University of California at San Francisco (UCSF) has concluded there may be problems with how readmissions rates are reported. According to the study, comparing publicly available overall readmission rates can lead to misinformation
The researchers looked at spinal encounters from 2007-2011 at UCSF Medical Center collected from a database maintained by an organization named UHCdatabase. The analysis led them to the estimation that all cause readmission rates overestimate unplanned readmissions by up to 25 percent. All cause readmission rates, which is the Centers for Medicare and Medicaid (CMS) reported metric, don’t distinguish between planned, scheduled, staged surgeries and unplanned surgeries for complications, according to the researchers.
With planned rehospitalizations for spinal surgeries at UCSF Medical Center in institutional readmission rates, there is an inappropriateness of readmission rates currently being reported says the researchers. Hundreds of hospitals nationwide whose readmission rates are all tracked with this same algorithm.
“Publicly reported ‘all cause’ readmission rates may not be realistic,” said Praveen Mummaneni, M.D. the senior author of the report, said in a statement. “To be accurate, substantial drill down of readmission rates is needed to find clinically relevant causes.”
Such rates, the authors note, are also publically reportable, and they may influence how consumers perceive the quality of care they will receive at places like the UCSF Medical Center.
Readmission rates, for instance, do not take into account the complexity of correcting problems involving the spine, which often call for two or more staged surgeries spaced out over several weeks, says Mummaneni. Publicly reported readmission rates do not always take into account scheduled follow-up surgeries and unplanned hospital readmissions, causing the calculated rates to be over-estimated. Additionally, he said, this problem may present surgeons with a tough choice between scheduling multiple surgeries, which may be better for the patients, and scheduling single surgeries, which would improve readmission rate calculations.
