Hospital Readmission Rates: Are We Measuring the Right Thing?

In this issue, Kaboli and colleagues (1) examined the relationship between hospital length of stay (LOS), hospital readmission rates, and mortality for more than 4 million veterans hospitalized in 1 of the 129 Veterans Affairs (VA) acute care facilities. Over a 14-year period, they showed that hospital LOS decreased approximately 27%, 30-day hospital readmissions rates decreased by 25%, and 90-day mortality rates actually improved. This study builds on their earlier work, which showed that an average hospital LOS was longer in VA facilities than in non-VA facilities (2). In the past decade, it seems that the VA has closed the LOS gap with non-VA facilities without sacrificing higher readmission rates or worsening outcomes for patients. Drilling down further, Kaboli and colleagues examined these same rates within separate diagnostic categories, some of which will be targeted by Medicare for penalty should patients hospitalized for the condition be readmitted within 30 days: heart failure, chronic obstructive pulmonary disease, community-acquired pneumonia, acute myocardial infarction, and gastrointestinal hemorrhage. Similar trends were found in each subset of patients as those that were reported in the total sample. However, less than 20% of the sample of older, chronically ill veterans fell into one of these groups, meaning that taking a disease-specific approach in an attempt to further reduce hospital readmission rates is not likely to lower the overall rate to a large extent. In this study, no single diagnostic category accounted for more than 5% of hospitalizations.