The Centers for Medicare and Medicaid Services (CMS) oversees the Hospital Readmissions Reduction Program (HRRP). Lawmakers developed this program to help better ensure the provision of quality, value-based care. To help achieve this goal, the HRRP reviews hospitals’ readmission rates. The agency will then penalize hospitals that fail to meet set expectations.
A recent study delves into the margin of error when using this data and reports the agency may have issued penalties based on faulty information.
What was the error?
Researchers reviewed HRRP data from thousands of hospitals throughout the country. According to the study, the agency incorrectly penalized hospitals due to misclassification of errors. The most common examples that led to faulty penalties were readmissions as a result of acute myocardial infarction, heart failures and pneumonia. Ultimately, researchers estimate the current systems results in misclassification of almost one-third, 31%, of hospitals.
If accurate, the finding is significant. To address the issue, the researchers call on the CMS to expand their data collection process. Unfortunately, the researchers note that an adequate evaluation period would likely be too long for appropriate assessment. For myocardial infarction, for example, the group states 12 years of data analysis would be more appropriate. Even with this extension, the researchers admit the error rate would still be relatively high. In this example, although reduced from 31% the error rate would likely still be around 20%.
What is the takeaway lesson?
Hospital executives and those who own private practices need to note that penalties assessed as a result of the HRRP and other government programs may not be accurate. As a result, hospital leaders and those who own private practices that are accused of such failings should ask questions, do research, and, if appropriate, challenge the penalty.