By Raquel Villatoro/ Texas Health Fellowship
How to use CMS hospital readmission data in your reporting
At HJ24, AHCJ Patient Safety Health Beat Leader Mary Chris Jaklevic spoke about which key hospital measures reporters should use and how to use them.
In 2016, the U.S. Centers for Medicare & Medicaid Services (CMS) began rating hospitals from one to five stars. Mortality and readmissions count as one half of a star rating. These ratings are important because hospital financial fortunes are tied to the ratings, Jaklevic said.
“Here’s a dirty little secret about the star rating system,” Jaklevic said. “There isn’t a lot of difference between a one-star hospital and a five-star hospital.”
Readmissions are defined as anyone returning to the hospital after 30 days of discharge. Mortality is defined as the rate at which patients die within 30 days of admission to the hospital. CMS assesses these measures based on Medicaid billing data. They are risk adjusted based on age, comorbidity and severity of illness, said Jaklevic.
Mortality measures tracked by CMS include heart attack, stroke, pneumonia, heart failure, COPD, and serious fatal complications following surgery. In addition, CMS reports 3 additional measures focused on outpatients like chemotherapy and surgery, Jaklevic said.
She noted that it is important to pay attention to these measures because they measure what patients care about most.
“How good is this hospital at keeping me alive? How good is this hospital at giving me the appropriate treatment, giving me the appropriate discharge instructions so that I’m not going to return?” Jaklevic said.
The measures have pitfalls, however, due to the age of the data and time it takes to update. Other factors can make the data biased. For example, hospice care is not included in mortality rates. One story reporters can look into is patients being transferred to hospice care right before they died, Jaklevic said.
“The allegation was that hospitals were trying to reduce their mortality rates,” Jaklevic said.
Patients at safety net hospitals — medical centers that provide health care to individuals regardless of their insurance status or ability to pay — do not have the same access to hospice care. “There’s an argument that mortalities are biased against safety net hospitals,” Jaklevic said.
When looking at readmissions data, one of the gaps in data are observational days where the patient stays the night in a hospital bed but is billed as an outpatient. Although this is an increasing trend in hospitals, it is not included, according to Jaklevic.
Another limitation is the lack of social adjustment for the severity of a patient’s health. There is no adjustment for community factors such as poverty, homelessness and disability, Jaklevic said.
Under the Hospital Readmissions Reduction Program, CMS can withhold 3% of a hospital’s funding for excess readmission for certain conditions.
“If CMS were rating Babe Ruth, they would give him three stars,” Jaklevic said. “They would give him a five star for hitting, but he’d only get one star for stealing bases. So he’d be a three-star baseball player. In other words, you have to look at the individual measures to really see what’s going on in hospital quality.”
Tyler Morning Telegraph multimedia journalist Raquel Villatoro covers health challenges in east Texas as a Report for America corps member. Villatoro is bilingual, first-generation and a Houstonian.
