On average, 1 in 5 Medicare beneficiaries who are discharged from a hospital today will re-enter the hospital within a month. Reducing the rate of hospital readmissions to improve quality and achieve savings are key components of President Obama's health care reform agenda. Research has shown that hospital readmissions are reducing the quality of health care while increasing hospital costs.
Important new information was added today to the Centers for Medicare & Medicaid Services' (CMS) Hospital Compare Web site that reports how frequently patients return to a hospital after being discharged, a possible indicator of how well the facility did the first time around.
On average, 1 in 5 Medicare beneficiaries who are discharged from a hospital today will re-enter the hospital within a month. Reducing the rate of hospital readmissions to improve quality and achieve savings are key components of President Obama's health care reform agenda.
"The President and Congress have both identified the reduction of readmissions as a target area for health reform," said HHS Secretary Kathleen Sebelius. "When we reduce readmissions, we improve the quality of care patients receive and cut health care costs."
With the update announced today, Hospital Compare will provide better data on the previously posted mortality rates for individual hospitals, as well as the new data on 30-day readmissions for heart attack, heart failure, and pneumonia. Previously, Hospital Compare had provided only mortality rates for these three conditions.
Research has shown that hospital readmissions are reducing the quality of health care while increasing hospital costs. Hospital Compare data show that for patients admitted to a hospital for heart attack treatment, 19.9 percent of them will return to the hospital within 30 days, 24.5 percent of patients admitted for heart failure will return to the hospital within 30 days, and 18.2 percent of patients admitted for pneumonia will return to the hospital within 30 days.
"Providing readmission rates by hospital will give consumers even better information with which to compare local providers," said Charlene Frizzera, CMS Acting Administrator. "Readmission rates will help consumers identify those providers in the community who are furnishing high-value healthcare with the best results."
CMS has been tracking the outcomes of hospital care since 2007 when Hospital Compare debuted 30-day mortality rates for heart attack and heart failure. Thirty-day mortality rates for pneumonia were added to the Web site in 2008.
This year, CMS has changed the way it calculates the mortality data to provide even better information to consumers. In 2007 and 2008, Medicare used only one year of claims data to compute mortality, while the rates added to the Web site today encompass three full years of claims data (from July 1, 2005 - June 30, 2008). Although this means that consumers cannot compare data from last year's rate with this year's rate, the expanded data set should provide a clearer picture of how well hospitals are performing.
Using the three-year data method, CMS estimates that the national 30-day mortality rate for patients originally admitted for heart attack care is 16.6 percent. For heart failure patients, the national 30-day mortality rate is 11.1 percent, and for pneumonia patients the national rate is 11.5 percent.
"Using three years of data for our mortality measures is a critical development in our effort to inform the public about hospital quality," said Barry M. Straube, M.D., CMS Chief Medical Officer and Director of the Agency's Office of Clinical Standards & Quality. "More data gives a clearer picture of the quality of care delivered at different hospitals over time, which ultimately increases the value of our mortality information to hospital patients, health care payers, employers, policymakers, and other health care stakeholders."
Both the mortality and the readmissions measures have been endorsed by the National Quality Forum (NQF) and are supported by the Hospital Quality Alliance (HQA). These measure endorsement processes are instrumental in facilitating CMS's communication with hospitals and helping to motivate those hospitals to continually analyze and improve the quality of their care. Collaboration achieved through the CMS measure development process, the NQF and HQA continues to ensure that public reporting efforts for hospitals are supported by a broad cross section of the health care community.
Both sets of measures are risk-adjusted and take into account previous health problems to "level the playing field" among hospitals and to help ensure accuracy in performance reporting.
The Hospital Compare Web site will show a hospital's mortality or readmissions rate is "Better than," "No different from," or "Worse than" the U.S. national rate. This data information includes each hospital's risk-standardized mortality rate (RSMR), an estimate of the rate's certainty (also known as the interval estimate), and the number of eligible cases for each hospital. By posting hospital RSMRs, interval estimates, and the number of eligible cases, CMS is giving consumers and communities additional insight into the performance of their local hospitals in hopes that this will prompt all hospitals to work toward achieving the level of the top-performing hospitals in the country.
Hospital Compare also includes 10 measures that capture patient satisfaction with hospital care, 25 process of care measures, and two children's asthma care measures. The site also features information about the number of selected elective hospital procedures provided to patients and what Medicare pays for those services.
Public reporting of these and other measures is intended to empower patients and their families with information they need to engage their local hospitals and physicians in active discussions about quality of care. "CMS believes that all hospitals, regardless of their readmission and mortality rates, should use the data available in these free, detailed reports to find ways to continually improve the care they deliver," said Frizzera.
CMS urges consumers not to view any one process or outcome measure on Hospital Compare as a tool to "shop" for a hospital. The information contained on Hospital Compare is available for consumers to use in making health care decisions; although, consumers should gather information from multiple sources when choosing a hospital. For example, patients and caregivers could use the Web site to help them discuss plans of care with their trusted health care providers. In an emergency situation, patients should always go to the nearest, most easily accessible facility.
Consumers have relied on Hospital Compare since 2005 to provide information about the quality of care provided in over 4,700 of America's acute-care hospitals. In 2008 alone, Hospital Compare had over 18 million page views, and has received about 1 million page views each month of 2009 thus far - www.hospitalcompare.hhs.gov
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