NQF Endorses All-Cause Unplanned Readmissions Measures

Washington, D.C. – The National Quality Forum (NQF) Board of Directors has endorsed two measures that address all-cause unplanned readmissions in hospitals – an area of healthcare targeted for improvement given national imperatives to make healthcare safer, more affordable, and keep people healthy.

“Almost one in five Medicare beneficiaries that leave a hospital end up being readmitted within 30 days,” said Janet Corrigan, PhD, MBA, president and CEO of NQF. “Those readmissions cost about $15 billion annually, and many have the potential to be prevented. These new measures help push us as a nation to address this serious problem.”

Research shows an avoidable hospital readmission can mean prolonged illness, emotional distress, and loss of productivity. Readmissions are attributable to a wide range of factors, including the availability of social supports and post-acute care for people, especially those of low income, as they transition from the hospital back into the community.

The first measure endorsed, developed by the National Committee for Quality Assurance (NCQA), counts the number of inpatient stays for patients aged 18 and older during a measurement year that were followed by an acute readmission for any diagnosis to any hospital within 30 days. It contrasts this count with a calculation of the predicted probability of an acute readmission. NCQA’s measure is intended for quality monitoring and accountability at the health plan level.

The second measure, co-developed by the Centers for Medicare & Medicaid Services (CMS) and researchers at Yale University, estimates the risk-standardized rate of unplanned, all-cause readmissions to a hospital for any eligible condition within 30 days of hospital discharge for patients aged 18 and older. The measure will result in a single summary risk-adjusted readmission rate for conditions or procedures that fall under five specialties: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology. The CMS/Yale measure is specified for evaluating hospital performance.

NQF worked with both measure developers to assure that the two measures will be harmonized to ensure that the measures assess readmissions in a similar manner. For example, both measures will be aligned to remove the same set of planned readmissions.

In endorsing the CMS/Yale measure, the NQF Board offered the following guidance to accompany the measure and help explain the multifaceted nature of hospital readmissions and the opportunity for broad stakeholder collaboration to help address the issue:

“Multiple factors affect readmission rates and other measures including: the complexity of the medical condition and associated therapies; effectiveness of inpatient treatment and care transitions; patient understanding of and adherence to treatment plans; patient health literacy and language barriers; and the availability and quality of post-acute and community-based services, particularly for patients with low income. Readmission measurement should reinforce national efforts to focus all stakeholders’ attention and collaboration on this important issue.”

“The recently endorsed NCQA and CMS/Yale measures will focus attention on the multiple patient and system factors which influence re-hospitalizations,” said Sherrie Kaplan, PhD, MPH, assistant vice chancellor for healthcare measurement and evaluation and professor of medicine, University of California, Irvine School of Medicine and co-chair of the All-Cause Readmissions project steering committee. “These measures will hopefully encourage increased communication and collaboration among all the stakeholders needed to reduce avoidable re-hospitalizations.”

Readmissions are the subject of many healthcare improvement initiatives. HHS’s Partnership for Patients initiative set a goal to reduce readmissions across all settings of care by 20 percent in 2013 compared to 2010 rates. The NQF-convened National Priorities Partnership (NPP), a group of 51 organizations from across the healthcare spectrum, supports this and other efforts, and has pledged to dedicate a substantial portion of its work on helping reduce readmissions in the coming year.

NQF is a voluntary consensus standards-setting organization. Any party may request reconsideration of the endorsed quality measures listed below by submitting an appeal no later than May 23 (to submit an appeal, go to the NQF Measure Database). For an appeal to be considered, the notification must include information clearly demonstrating that the appellant has interests directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

Endorsed Measures
1768: Plan all-cause readmissions (NCQA)
1789: Hospital-wide all-cause readmission measure (CMS/Yale)