In the Journals

Hospital readmissions for patients with ESRD may be due to underlying health issues, not kidney-related care

Repeated hospital readmissions for patients with ESRD may not be due to the quality of the kidney care being provided but to other comorbidities that increase patients’ risk of re-hospitalization, according to study findings.

The distinction is important, wrote Eugene Lin, MD, and colleagues from the University of Southern California and Stanford University, because while readmissions add higher Medicare costs for treating patients with ESRD – about $1.3 billion annually – dialysis providers are being financially penalized through CMS initiatives like the quality incentive program for readmissions when it may not be clear that the cause was ESRD-related.

“As currently formulated, quality measures do not account for the relatedness of 30-day readmissions and using all-cause 30-day readmissions as a quality benchmark might lead policy makers and providers to conflate poor-quality care with care for sicker and socioeconomically disadvantaged patients,” the authors wrote. “ ... A large proportion of related 30-day readmissions are likely preventable with improved care coordination and more effective follow-up.” Health care payers, such as Medicare, should consider using clinical relatedness with 30-day readmission quality measures to get a clearer understanding of the medical cause of the readmission, they wrote.

The researchers used the U.S. Renal Data System to isolate 677,868 index hospitalizations from 231,330 patients with a discharge date from Jan. 1, 2013 to Dec. 1, 2014. The primary focus in reviewing the data was on identifying index, or original cause, for hospitalizations, and then identifying the patients and the cause of multiple readmissions.

“We categorized a hospitalization, 30-day readmission pair as ‘related’ if the principal diagnoses came from the same organ system,” the authors wrote.

The results showed that as the number of re-hospitalizations increased, the cause was less likely related to the index or original reason for hospitalization. The adjusted probability of unrelated 30-day readmission after any index hospitalization was 19.1% in patients with no hospitalizations and increased to 31.2% in patients with five or more hospitalizations. Specific to renal disease, renal index hospitalizations had the lowest adjusted probability of related 30-day readmission (range of 2% to 5.1% depending on the number of visits). Cardiovascular index hospitalizations, however, had the highest adjusted probability of related 30-day readmission, with a range of 10.4% to 20.8%.

Disclosure: The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute on Aging of the NIH.

Repeated hospital readmissions for patients with ESRD may not be due to the quality of the kidney care being provided but to other comorbidities that increase patients’ risk of re-hospitalization, according to study findings.

The distinction is important, wrote Eugene Lin, MD, and colleagues from the University of Southern California and Stanford University, because while readmissions add higher Medicare costs for treating patients with ESRD – about $1.3 billion annually – dialysis providers are being financially penalized through CMS initiatives like the quality incentive program for readmissions when it may not be clear that the cause was ESRD-related.

“As currently formulated, quality measures do not account for the relatedness of 30-day readmissions and using all-cause 30-day readmissions as a quality benchmark might lead policy makers and providers to conflate poor-quality care with care for sicker and socioeconomically disadvantaged patients,” the authors wrote. “ ... A large proportion of related 30-day readmissions are likely preventable with improved care coordination and more effective follow-up.” Health care payers, such as Medicare, should consider using clinical relatedness with 30-day readmission quality measures to get a clearer understanding of the medical cause of the readmission, they wrote.

The researchers used the U.S. Renal Data System to isolate 677,868 index hospitalizations from 231,330 patients with a discharge date from Jan. 1, 2013 to Dec. 1, 2014. The primary focus in reviewing the data was on identifying index, or original cause, for hospitalizations, and then identifying the patients and the cause of multiple readmissions.

“We categorized a hospitalization, 30-day readmission pair as ‘related’ if the principal diagnoses came from the same organ system,” the authors wrote.

The results showed that as the number of re-hospitalizations increased, the cause was less likely related to the index or original reason for hospitalization. The adjusted probability of unrelated 30-day readmission after any index hospitalization was 19.1% in patients with no hospitalizations and increased to 31.2% in patients with five or more hospitalizations. Specific to renal disease, renal index hospitalizations had the lowest adjusted probability of related 30-day readmission (range of 2% to 5.1% depending on the number of visits). Cardiovascular index hospitalizations, however, had the highest adjusted probability of related 30-day readmission, with a range of 10.4% to 20.8%.

Disclosure: The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the National Institute on Aging of the NIH.