How Medicare-Only Patient Analysis Impacts Hospital Readmission Rankings

Beginning with 2016 third quarter data, VHHA is providing hospital standardized readmission rankings using Medicare-only patient data, as well as all-payer patient data because hospitals officials have expressed interest in seeing the population that the Centers for Medicare & Medicaid Services (CMS) reviews. Considering the concerns that patients with multiple readmissions are often younger and chronically ill, a natural question for members of the members of the hospital community is whether the all-payer ranking overstates the number of readmissions being assigned to them. The chart below tracks each hospital’s pneumonia readmissions for Medicare-only patients in Virginia (2016, Q4) and compares it to a hospital’s ranking when patients of all ages are included. Roughly half of Virginia’s hospitals improve their state ranking (represented by green circles) when Medicare-only patients are in the ranking; approximately the same number score lower (represented by red circles). A smaller number of hospitals show only minor changes. Similar findings occur when the same scenario is charted based on other readmission conditions such as heart failure, hip and knee replacements, or chronic obstructive lung disease (COPD). Instead of focusing on ranking, a better approach is to determine why a change occurs. As insurance status is consistent, access to care should be equal. Socioeconomic status may affect patients’ perceptions about seeking care or willingness to purchase needed medicines. The quality of transitions between hospitals, home, or post-acute care facilities may also influence senior citizens’ ability to remain at home after a hospitalization. Since there is no discernable pattern to which hospital or health system type improves its ranking when Medicare-only patients are included, each hospital is advised to evaluate its own experience. Hospital officials who want to learn about their facility status when Medicare-only patients are ranked, in comparison to an all-payer ranking, may contact the VHHA Analytics Team. (5/5)

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