Preventable Readmission Measure No Better than All-Cause, Investigators Say

Matt Malcolm, PhD

The Potentially Preventable 30-Day Post-Discharge Readmission Measure for inpatient rehabilitation reduced readmission rates but did not distinguish high- and low-performing facilities, compared to an unplanned all-cause readmission model.

Matt Malcolm, PhD, from the Department of Occupational Therapy at Colorado State University, and a team of investigators, sought to learn if Centers for Medicare & Medicaid Services (CMS) Quality Reporting Program measures can detect variation in 30-day hospital readmission rates after inpatient rehabilitation at US inpatient rehabilitation facilities. The team compared the Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation to the All-Cause Unplanned Readmission Measure for 30 Days Post Discharge From Inpatient Rehabilitation Facilities.

The team analyzed nearly 455,000 Medicare fee-for-service beneficiaries discharged from 1162 inpatient rehabilitation facilities submitting claims and found that preventable readmission rates ranged from 4.3—7.3%, while all-cause ranged from 10.1–15.9%.

The findings suggest that current measures do not show high- and low-performing facilities and should not be implemented as part of the Quality Reporting Program, the study authors wrote.

Unnecessary hospital readmissions are costly, resource intensive, and could expose patients to additional risks. CMS adopted the All-Cause Unplanned Readmission Measure for 30 Days Post Discharge From Inpatient Rehabilitation Facilities to reduce readmission in the 30 days post-discharge from an inpatient facility. The agency then transitioned to the potentially preventable readmission measure, which focuses on conditions for which a rehospitalization should be avoidable with more appropriate discharge plans and follow-up care.

The investigators collected data from the Medicare Provider Analysis and Review, Medicare Beneficiary Summary, Medicare Inpatient Rehabilitation Facility-Patient Assessment Instrument, and Medicare Provider Service. The data included claims for stays in inpatient rehabilitation facilities, acute care hospitals, skilled nursing facilities, and psychiatric hospitals.

Malcolm and his colleagues included 454,378 Medicare fee-for-service beneficiaries discharged between June 2013 and July 2015. The investigators primarily focused on all-cause readmission rate and potentially preventable readmission rate.

Readmission rates were lower when the investigators used the Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation, compared with the recently discontinued All-Cause Unplanned Readmission Measure for 30 Days Post Discharge From Inpatient Rehabilitation Facilities.

The overall all-cause readmission rate was 12.3% (95% CI, 12.2—12.4), while the overall potentially preventable readmission rate was 5.3% (95% CI, 5.2–5.4). Across the inpatient rehabilitation facilities, risk-standardized rates using the All-Cause measure ranged from 10.1% (95% CI, 8.9–11.6) to 15.9% (95% CI, 13.6–18.6). The risk-standardized rates using the potentially preventable readmission measure ranged from 4.3% (95% CI, 3.7–5.4) to 7.3% (95% CI, 5.7–8.3).

When the investigators used the All-Cause Unplanned Readmission Measure for 30 Days Post Discharge From Inpatient Rehabilitation Facilities, 16 (1.4%) had 95% confidence intervals above the national mean rate, 1137 (97.9%) contained the national mean rate, and 9 (0.8%) were below the national mean rate.

Using the Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation, 8 (0.7%) had 95% confidence intervals above the national mean rate, 1153 (99.2%) contained the national mean rate, and 1 (0.1%) fell below the national mean rate.

The current Potentially Preventable 30-Day Post-Discharge Readmission Measure for Inpatient Rehabilitation should not be implemented as part of the inpatient rehabilitation facility Quality Reporting Program, the Malcolm and colleagues concluded. The measure fails to discriminate quality performance.

Additional research is needed to develop new rehabilitation-relevant and sensitive measures to track inpatient rehabilitation care quality.

The study, “Variation in Facility-Level Rates of All-Cause and Potentially Preventable 30-Day Hospital Readmissions Among Medicare Fee-for-Service Beneficiaries After Discharge From Postacute Inpatient Rehabilitation,” was published online in JAMA Network Open.