Cardiology patients have better survival rates at hospitals atop the U.S. News and World Report rankings, but the risk of readmission is more or less the same -- and with 30-day readmissions tied to reimbursement, that could pose an issue for providers at all points on the spectrum.
The top 50 hospitals showed consistently low 30-day risk-standardized mortality rates for cardiology and heart surgery. Combined, they had an 11.9 percent mortality rate for myocardial infarctions (vs. 13.2 percent for the rest), 9.5 percent for heart failure (compared to 11.9 percent for the rest), and 2.3 percent for coronary artery bypass grafting (vs. 3.3 percent).
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Despite the good news on the mortality front, to-ranked hospitals fared no better, at least statistically, when it came to 30-day readmission rates. The rates at top performers for acute MI were 16.7 percent (vs. 16.5 percent); heart failure readmission rates were 21 percent (vs. 19.2 percent); and coronary artery bypass grafting readmission rates were 14.1 percent (vs. 13.7 percent).
The authors say the findings raise questions as to whether readmission rates are indeed an accurate marker of care quality, in particular for heart conditions.
They partially attribute the disparity in mortality and readmission rates to the Hospital Readmission Reduction Program, which incentivized hospitals to improve patient care even following discharge but may have led to some hospitals taking shortcuts around financial penalties, leading to increased mortality rates for things like heart failure and pneumonia.
Top-ranked hospitals did garner better HCAHPS rankings for patient satisfaction, averaging 3.9 out of 5 stars, compared to 3.3 stars among non-ranked hospitals.
Hospitals in various states have been slammed by readmission penalties, including 215 of 292 hospitals in California.
The penalties for some will involve up to 3 percent of Medicare fee-for-service reimbursements. How high the percentage actually gets depends on the amount of Medicare claims a hospital makes.
Either way, even a small reimbursement hit can translate to significant financial losses. A 0.2 percent penalty, such as the one incurred by Ventura County Medical Center and the affiliated Santa Paula Hospital, can translate into tens of thousands of dollars in lost revenue.