The Opportunity
The unpredictable nature of a patient’s path once they are discharged from the hospital is a byproduct of a fragmented healthcare delivery system. This is especially true for patients who suffer from chronic and comorbid conditions. Previous studies have shown that nearly one in five Medicare patients are readmitted to the hospital within 30 days of discharge, including many patients returning via the emergency room, costing upwards of $26 billion annually.1,2
Building on promising news from the Centers for Medicare & Medicaid Services (CMS) that nearly all states are reducing Medicare readmission rates, more can be done to reduce potentially avoidable returns to the hospital. Readmissions within 30 days of discharge can be a sign of poor quality of care, is disruptive for patients and costs the Medicare program more than $17 billion annually. The federal government’s readmissions payment levers have sharpened the focus on hospitals’ efforts to support patients and families, especially those managing multiple chronic conditions, manage their health and avoid readmission. Measures can provide clinicians with critical information to help them better address patients’ health needs right before and after they leave the hospital and keep them from unnecessarily returning.
The causes of readmissions are complex. Many factors may affect hospital readmission rates, including the complexity of their healthcare needs as well as environmental and patient characteristics, such as their socioeconomic and demographic status (e.g., education, incomes, literacy, home status). NQF has undertaken a number of projects addressing admissions and readmissions that are condition or setting-specific. This is the third phase of the all-cause admissions and readmissions project at NQF.
In addition to measure endorsement projects, NQF has pursued other work related to admissions and readmissions. NQF’s Measure Applications Partnership (MAP) recommended that readmission measures should be part of a suite of measures promoting a system of patient-centered care coordination. This conclusion recognized that multiple entities and individuals are jointly accountable for reducing avoidable readmissions, that assessment of performance should include measures of both avoidable admissions and readmissions, and additionally should address important care coordination processes and readmissions.3
As we move towards a model of accountable care organizations using readmissions measures as part of a suite in conjunction with quality measures looking at admissions and length of stay, we can achieve greater efficiencies (lower LOS) and improvements in quality (reductions in readmissions and mortality).
About the Project
This project will evaluate measures related to all-cause admissions and hospital readmissions that can be used for accountability and public reporting for all populations and in all settings of care. This project will address topic areas including but not limited to:
- All-Cause and condition specific admission measures
- Condition-specific readmissions measures
- Measures following hospitalization from heart failure, pneumonia, total hip arthroplasty (THA) and/or total knee arthroplasty (TKA)
There are no maintenance measures undergoing review in the third phase of the Admissions and Readmissions project.
NQF Process
Candidate standards will be considered for NQF endorsement as national voluntary consensus standards. Consensus on the recommendations will be developed through NQF’s formal Consensus Development Process. This project involves the active participation of representatives from across the spectrum of healthcare stakeholders and will be guided by a Standing Committee.
In an effort to test improvements to the CDP, this project will pilot a continuous commenting feature, enabling the public and NQF membership to submit comments on an ongoing basis throughout the project. NQF will solicit stakeholder and public comment throughout the consensus development process. This pilot is intended to eliminate finite timeframes for the submission of comments, which is traditionally only solicited for a single 30-day period after Steering Committee recommendations for endorsement, and enable earlier and more frequent public and member inputs to the evaluation process.
Funding
This project is funded under NQF’s contract with the Department of Health and Human Services, Consensus-based Entities Regarding Healthcare Performance Measurement.
For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit: http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.
Contact Information
For further information, contact Erin O’Rourke at 202-783-1300 or via email at readmissions@qualityforum.org.
Notes
- Dartmouth Atlas Project, PerryUndem Research & Communications. The Revolving Door: A Report on U.S. Hospital Readmissions. Princeton, NJ:Robert Wood Johnson Foundation; 2013. Available at http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/02/the-revolving-door--a-report-on-u-s--hospital-readmissions.html
- Medicare Payment Advisory Committee (MEDPAC). Report to the Congress: Medicare and the Health Care Delivery System, DC: MedPAC; 2013. Available at http://medpac.gov/documents/Jun13_EntireReport.pdf
- MAP Pre-Rulemaking Report: 2013 Recommendations on Measures Under Consideration by HHS. Washington, DC: National Quality Forum; 2013 Feb. Available at https://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=72746