Why hospitals fear Measure #1789

'Stakes are high' for some hospitals

Topics: Readmissions, Quality, Performance Improvement

July 5, 2012

Seven hospital systems and the National Quality Forum (NQF) are locked in fierce disagreement over a new readmissions measure, which hospitals say will harm patient safety and unfairly affect their finances.

The provision, known as Measure #1789 and developed by CMS and Yale University, establishes one risk-standardized, unplanned, 30-day readmission rate per hospital for all conditions and procedures related to general medicine, neurology, cardiovascular care, cardiorespiratory care, surgery, and gynecology. CMS plans to partly base Medicare payments on readmissions beginning in fiscal year 2013.

According to NQF, about 20% of Medicare beneficiaries that are discharged from the hospital are readmitted within one month, costing $15 billion annually—and that does not comprise all readmissions.

Hospitals appeal to NQF to change measure

In a formal appeal to NQF, the health systems expressed concern that the measure may lead to unintended consequences; for example, "patients may be harmed if access to the hospital is impeded" as organizations introduce new strategies intended to curb readmissions. The appellants added that hospitals are simply not yet ready for the measure.

In response, the NQF board stood by its original endorsement, although clarified that CMS will not implement the measure until it goes through a special review this summer. The board also agreed to revisit how it reaches consensus, setting up a task force to explore changes to the process.

"NQF greatly appreciates and takes to heart the comments and concerns raised throughout this project," Janet Corrigan, CEO and president of NQF, said in a release. "This current project shows that reaching consensus is difficult, but any process that balances multistakeholder interests yields important results" (Monegain, Healthcare Finance, 7/2).

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