title: Does Use of a Hospital-wide Readmission Measure Versus Condition-specific Readmission Measures Make a Difference for Hospital Profiling and Payment Penalties?
abstract: BACKGROUND
  The Centers for Medicare and Medicaid Services (CMS) use public reporting and payment penalties as incentives for hospitals to reduce readmission rates. In contrast to the current condition-specific readmission measures, CMS recently developed an all-condition, 30-day all-cause hospital-wide readmission measure (HWR) to provide a more comprehensive view of hospital performance.
  
  
  OBJECTIVE
  We examined whether assessment of hospital performance and payment penalties depends on the readmission measure used.
  
  
  METHODS
  We used inpatient data to examine readmissions for patients discharged from VA acute-care hospitals from Fiscal Years 2007-2010. We calculated risk-standardized 30-day readmission rates for 3 condition-specific measures (heart failure, acute myocardial infarction, and pneumonia) and the HWR measure, and examined agreement between the HWR measure and each of the condition-specific measures on hospital performance. We also assessed the effect of using different readmission measures on hospitals' payment penalties.
  
  
  RESULTS
  We found poor agreement between the condition-specific measures and the HWR measure on those hospitals identified as low or high performers (eg, among those hospitals classified as poor performers by the heart failure readmission measure, only 28.6% were similarly classified by the HWR measure). We also found differences in whether a hospital would experience payment penalties. The HWR measure penalized only 60% of those hospitals that would have received penalties based on at least 1 of the condition-specific measures.
  
  
  CONCLUSIONS
  The condition-specific measures and the HWR measure provide a different picture of hospital performance. Future research is needed to determine which measure aligns best with CMS's overall goals to reduce hospital readmissions and improve quality.
authors.affiliation: *Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System †Department of Surgery, Boston University School of Medicine ‡Boston University Questrom School of Business, Operations and Technology Management Department §VA Boston Healthcare System ∥Department of Health Law, Policy and Management, Boston University School of Public Health ¶Department of General Medicine, Boston University School of Medicine, Boston, MA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.forename: Corey
authors.initials: C
authors.lastname: Pilver
authors.forename: Hillary J
authors.initials: HJ
authors.lastname: Mull
authors.forename: Kamal F M
authors.initials: KF
authors.lastname: Itani
authors.forename: Ann
authors.initials: A
authors.lastname: Borzecki
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S. / Q000592:standards*; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012052:Reimbursement, Incentive / Q000592:standards / Q000706:statistics & numerical data; D020379:Risk Adjustment; D014481:United States