Just three years ago, the nation’s healthcare leaders and policymakers as well as patients and families struggled with high hospital readmission rates of 19 percent or more. At that time, an estimated one in five Medicare beneficiaries returned to the hospital within a month, causing stress and hardship on patients and costing the federal program $15 billion annually.
Medicare beneficiaries are not alone. The private sector also spends billions of dollars each year when discharged patients end up back in the hospital. Readmissions take a significant toll on all patients and their families, often resulting in prolonged illness or pain, emotional distress, and lost days at work.
The visibility of this issue rose in October 2011 when NQF reviewed and endorsed quality measures related to all-cause readmissions at the hospital and health plan levels. Though endorsement was controversial, these measures provided an important opportunity to understand and ultimately reduce unplanned hospital readmission rates across the country.
“This effort was truly groundbreaking, difficult, and challenging both technically and politically,” said Cristie Upshaw Travis, CEO of the Memphis Business Group on Health, who was a member of the NQF 2011 All-Cause Readmissions Committee and is now the chair of the NQF Consensus Standards Advisory Committee. “We learned a lot through our work on readmissions and that experience informed how NQF approaches other controversial topics.”
The endorsed measures that resulted from the 2011 work were recommended by the NQF-convened Measure Applications Partnership for use in the CMS Readmissions Reduction Program, launched in October 2012. In a single year, the program, which measures Medicare beneficiary readmission rates for heart attack, heart failure and pneumonia, resulted in readmissions dropping from 18.4 percent to 17.5 percent. Nearly 150,000 more Medicare beneficiaries were staying home to heal rather than returning to the hospital.
“This decrease is an early sign that our focus on improving quality and care coordination is beginning to have an impact,” said Patrick Conway, CMS chief medical officer and director of the Office of Clinical Standards and Quality in his 2013 testimony before the Senate Committee on Health Education and Labor and Pensions.
The CMS readmissions program is slated to expand with two additional readmission measures—chronic obstructive pulmonary disease and knee and hip replacements—in October 2014.