A study released by the Journal of the American Medical Association shows the main reason why patients need to be readmitted to the hospital has less to do with their original reason for hospitalization and more to do with new issues they acquired while in the hospital. Patients should question if better staffing in hospitals or more transparency in patient outcomes and staffing would lead to fewer readmissions.
This comes out just as hospitals are struggling with a record number of fines and penalties for high readmission rates. The Center for Medicaid and Medicare Services (CMS) is penalizing facilities where readmission rates are too high.
Complications from surgery for medical conditions—rather than from the medical conditions themselves—are the chief reason surgical patients required readmission within 30 days after their procedures, and life-threatening surgical site infections (SSIs) top the list.
That’s according to a report that examined audited medical records of nearly 500,000 patients who underwent surgery at 346 hospitals participating in an American College of Surgeons quality program in 2012.
“It’s a simple observation, but it has very profound implications,” says Karl Bilimoria, MD, assistant professor in surgery-surgical oncology at Northwestern University in Chicago, corresponding author of the published in JAMA Tuesday. “The world thinks that readmissions of patients are related to problems with transitions of care and how you manage the [medical] conditions, but for patients undergoing surgery, it’s not that at all.”
Instead, common, known surgical complications that appear after discharge, such as SSIs, bowel obstructions, and bleeding, stem from the surgical procedure itself, Bilimoria says.
That’s important, especially since higher rates of readmissions now result in hospital penalties as high as 3% of a hospital’s Medicare payment, and hip and knee procedures are now included in the equation, Bilimoria says. In 2016, CMS will add coronary artery bypass graft procedures to the readmission penalty algorithm.
Bilimoria says that despite many initiatives to reduce SSIs, preventing them has been extremely tough and largely unsuccessful. That’s because the telltale signs of infection: redness, fever and other signals don’t show up until seven to 10 days or longer after the patient is discharged.
“As surgeons, we’ve been trying hard for centuries, and [there are] a lot of great efforts ongoing to reduce these complications, and we’ve made a small dent,” he says. “But wound infections still happen, and it’s just not something we have a magic bullet for, that we can stop and drive to zero,” even if a hospital implements all known best practices.
Readmitting these patients is the right thing to do, Bilimoria says.
He adds: “If we’re going to act on readmissions to reduce them, it’s important to know why they’re happening, and important from a policy standpoint to know that it might not be so easy to reduce readmissions for these patients. And therefore, our policy regarding readmission reductions may not be very effective.”
Bilimoria says that without a better effort to understand the cause and timing of surgical site infections, the current policy may provoke some unintended consequences. It may, he says, prompt some doctors “to try to skirt a readmission by treating patients with surgical infections in the clinical practice instead of sending them to the hospital, which could lead to a worsening of the condition.”