Readmission Measures Overview
Publicly reporting risk-standardized, 30-day readmission measures for AMI, HF and PN
The Deficit Reduction Act (DRA) of 2005 mandated that the Secretary of Health and Human Services make outcome and efficiency measures publicly available under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program. To improve both efficiency and quality of our nation’s hospitals, and in response to the requirements of the DRA, the Centers for Medicare & Medicaid Services (CMS) has developed three risk-standardized, 30-day readmission measures for acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN) patients. Readmissions are often expensive, adverse events for patients. The Medicare Payment Advisory Commission (MedPAC) has identified AMI, HF, PN readmissions as common, costly, and often preventable (MedPAC 2007). Measuring and reporting readmission rates will provide information to consumers and create incentives for hospitals and health systems to:
- evaluate the entire spectrum of care that they and their affiliated providers furnish to patients
- identify systemic or condition-specific changes that will make care safer and more effective
- invest in interventions that reduce complications of care
- better assess the readiness of patients for discharge
- improve discharge instructions
- reconcile medications
- more carefully transition patients to outpatient care or other institutional care
The 30-day readmission measures focus on Medicare Fee-for-Service patients, at least 65 years of age, with a principal diagnosis of AMI, HF, or PN. These conditions are common among the Medicare beneficiary population, are associated with substantial mortality and morbidity, and have considerable variation in outcomes across U.S. hospitals. Readmission within 30 days can be strongly influenced by hospital care and the initial transition to outpatient status. The readmission measures complement the process-of-care quality and mortality measures for these three conditions already reported on Hospital Compare (http://www.hospitalcompare.hhs.gov). These measures increase the transparency of care for consumers and encourage hospitals to investigate their patient outcomes to assure that they are providing the right care for every patient, every time.
Background and Process
The risk-standardized AMI, HF, and PN readmission measures were developed by a team of clinical and statistical experts from Yale and Harvard universities, using a methodology that has been published in peer reviewed literature. The measures comply with standards for publicly reported outcomes models set forth by the American Heart Association and the American College of Cardiology. All three measures have been endorsed by the National Quality Forum and adopted for reporting by the Hospital Quality Alliance. The measures are updated annually to ensure the models are performing well, given trends in the underlying data. Also, prior to public reporting of these measures, CMS conducted a national dry run of the HF measure to educate hospitals about the measure methodology and respond to their questions and comments. (Since the measure methodology for the AMI and PN readmission measures is similar to that for the HF measure, CMS decided not to conduct dry runs for the AMI and PN readmission measures.)
Hospital-Specific Reports (HSRs) are distributed to participating hospitals for each annual preview period prior to public reporting. Each hospital’s report describes the measures’ calculation methodology, lists patients considered for and those included in the analysis, and presents the results for that hospital.
Questions and Comments
CMS has contracted with Mathematica Policy Research, Inc. to implement these measures. Questions about the 30-day readmission measures may be sent to Mathematica at: readmissionmeasures@mathematica-mpr.com.