University of Michigan, 2800 Plymouth Rd, Bldg 16, Room 430W, Ann Arbor, MI 48109-2800. Email:
Am J Manag Care. 2018 Dec 1;24(12):e399-e403.
To (1) compare the 2015 hospital grades reported on Medicare's Hospital Compare website for heart failure (HF) and acute myocardial infarction (AMI) readmissions with the HF- and AMI-specific scores for excess readmissions used to assess Medicare readmission penalties and (2) assess how often hospitals were penalized for excess readmissions in only 1 or 2 conditions, given that hospitals received a penalty impacting all Medicare payments based on an overall readmission score calculated from 5 conditions (HF, AMI, pneumonia, chronic obstructive pulmonary disease, and total hip/knee arthroplasty).
Retrospective secondary data analysis.
Descriptive analyses of hospital-specific, condition-specific grades and excess readmission scores and hospital-level penalties downloaded from Hospital Compare.
Of the 2956 hospitals that had publicly reported HF grades on Hospital Compare, 91.9% (2717) were graded as "no different" than the national rate for HF readmissions, which included 48.6% that were scored as having excessive HF admissions, and 87% received an overall readmission penalty. Of 120 (4.1%) hospitals graded as "better" than the national rate for HF, none were scored as having excessive HF readmissions and 50% were penalized. AMI data yielded similar results. Among 2591 hospitals penalized for overall readmissions, 26.6% had only 1 condition with excess readmissions and 27.5% had 2 conditions.
Many hospitals with an HF and AMI readmission grade of "no different" than the national rate on Hospital Compare received penalties for excessive readmissions under the Hospital Readmissions Reduction Program. The value signal to consumers and hospitals communicated by grades and penalties is therefore weakened because the methods applied to the same hospital data produce conflicting messages of "average grades" yet "bad enough for penalty."
（1）比较 2015 年医疗保险医院比较网站上报告的心力衰竭（HF）和急性心肌梗死（AMI）再入院率与用于评估医疗保险再入院处罚的 HF 和 AMI 特定过度再入院评分，（2）评估在仅 1 或 2 种情况下，医院因过度再入院而受到处罚的频率有多大，因为医院根据从 5 种情况（HF、AMI、肺炎、慢性阻塞性肺疾病和全髋关节/膝关节置换术）计算的整体再入院评分而受到影响所有医疗保险支付的处罚。
回顾性二次数据分析。
从医院比较中下载医院特定、条件特定等级和过度再入院评分以及医院层面的处罚的描述性分析。
在有公开报告心力衰竭等级的 2956 家医院中，91.9%（2717 家）被评定为与心力衰竭再入院的全国率“无差异”，其中 48.6%的医院被评定为过度心力衰竭入院，87%的医院受到整体再入院处罚。在被评定为心力衰竭再入院率优于全国率的 120 家（4.1%）医院中，没有一家被评定为过度心力衰竭再入院，而 50%的医院受到处罚。AMI 数据得出了类似的结果。在因整体再入院而受到处罚的 2591 家医院中，26.6%的医院只有 1 种情况的过度再入院，27.5%的医院有 2 种情况。
许多在医院比较中 HF 和 AMI 再入院等级与全国率“无差异”的医院根据医院再入院减少计划因过度再入院而受到处罚。因此，向消费者和医院传达的等级和处罚的价值信号被削弱，因为应用于同一医院数据的方法产生了相互矛盾的“平均等级”但“处罚足够严厉”的信息。
