Hospital readmission disparity measure for evaluating hospital performance and penalties.

Abstract

Background: The excess readmission ratio (ERR) is currently used to determine penalties for hospitals with excessive readmission rates. To determine whether the effectiveness of alternative measures, such as the Risk-Standardized Readmission Rate (RSRR), or Excess Days in Acute Care (EDAC), or differences between paired measures, would provide comparable or superior assessments.

Methods: A retrospective national study on readmission measures. This study analyzed national readmission data from 3,047 hospitals for the fiscal year (FY) 2022. We measured the agreements and disparity scores in hospital performance assessments, as well as the changes in penalty status between the paired readmission measures.

Results: The ERR and RSRR measures showed a significantly high degree of agreement, ranging from 83.5 to 93.8% across the six applicable conditions/procedures. In contrast, marked differences emerged when comparing EDAC with ERR or RSRR, showing varying levels of disparities. If the EDAC measure were adopted, between 15.9 and 25.2% of hospitals would experience a change in their penalty status. Specifically, using EDAC would reduce financial penalties for 11.4-16.6% of small community hospitals and safety-net hospitals for at least one of the targeted conditions.

Conclusions: These findings suggest that integrating disparity scores into the current ERR-based measurement system could have significant implications for promoting equity and informing policy decisions. By doing so, the evaluation of individual providers and hospital care quality could become more comprehensive, insightful, accurate, and equitable.