Research Original Investigation
Hospital Readmission After Colorectal Cancer
Invited Commentary
It Is More Than Payment Accountability It Is About Improvement, Too Frank G. Opelka, MD
Using a large data set, Lucas et al1 studied the importance of appropriate risk adjustment when applying performance measures in payment and accountability programs. Despite limited variation in readmissions for colorectal cancer, a readmission rate of 12.3% should encourage all of us to strive Related article page 1272 to get below 10%. It is about improvement and accountability in payment and public reporting. The hierarchical logistic regression model used found variations in age, race, procedure, and comorbidities. Risk-adjusted readmission odds ratios revealed risks shared by all hospitals in these specific groups of variables. They also point to areas in need of focused improvements. The authors shed light on the concerns of raw data for readmissions, an approach that lends itself to misclassification of delivery systems and misguiding patients with the information if the analytics do not properly use risk adjustment and CIs. Lucas et al1 emphasize the importance of hierarchical reARTICLE INFORMATION Author Affiliation: Louisiana State University Health Science Center, New Orleans. Corresponding Author: Frank G. Opelka, MD, Louisiana State University Health Science Center, 433 Bolivar St, Room 820, New Orleans, LA 70112 ([email protected]).
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gression in thoughtful design of analytics to ensure “apples to apples” comparisons. The authors note that results from the Centers for Medicare & Medicaid Services (CMS) hierarchical model have inconsistencies in applying the results to payment programs when compared with the CMS public reporting programs. It seems that payment programs act without regard to CIs, whereas the CMS public reporting programs are respectful of their statistical effect. I take exception to the authors when they suggest a surgeon- and specialty-specific risk-adjusted readmission rate as a solution. Surgical practice profiles vary greatly even within general surgery, such as in the subspecialties of breast, bariatrics, trauma, hepatopancreaticobiliary, transplantation, pediatrics, and so forth. Patients need condition-, disease-, and procedure-specific information tailored to their informed decision needs. Focusing on the specific procedure with “fit for purpose” performance measures will drive health care closer to sensible accountability and will best propel improvement efforts.
Published Online: October 22, 2014. doi:10.1001/jamasurg.2014.994. Conflict of Interest Disclosures: None reported.
after colorectal cancer surgery [published online October 22, 2014]. JAMA Surg. doi:10.1001 /jamasurg.2014.988.
REFERENCE 1. Lucas DJ, Ejaz A, Bischof DA, Schneider EB, Pawlik TM. Variation in readmission by hospital
JAMA Surgery December 2014 Volume 149, Number 12
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a University of Georgia User on 06/03/2015
jamasurgery.com
Hospital Readmission After Colorectal Cancer
Invited Commentary
It Is More Than Payment Accountability It Is About Improvement, Too Frank G. Opelka, MD
Using a large data set, Lucas et al1 studied the importance of appropriate risk adjustment when applying performance measures in payment and accountability programs. Despite limited variation in readmissions for colorectal cancer, a readmission rate of 12.3% should encourage all of us to strive Related article page 1272 to get below 10%. It is about improvement and accountability in payment and public reporting. The hierarchical logistic regression model used found variations in age, race, procedure, and comorbidities. Risk-adjusted readmission odds ratios revealed risks shared by all hospitals in these specific groups of variables. They also point to areas in need of focused improvements. The authors shed light on the concerns of raw data for readmissions, an approach that lends itself to misclassification of delivery systems and misguiding patients with the information if the analytics do not properly use risk adjustment and CIs. Lucas et al1 emphasize the importance of hierarchical reARTICLE INFORMATION Author Affiliation: Louisiana State University Health Science Center, New Orleans. Corresponding Author: Frank G. Opelka, MD, Louisiana State University Health Science Center, 433 Bolivar St, Room 820, New Orleans, LA 70112 ([email protected]).
1278
gression in thoughtful design of analytics to ensure “apples to apples” comparisons. The authors note that results from the Centers for Medicare & Medicaid Services (CMS) hierarchical model have inconsistencies in applying the results to payment programs when compared with the CMS public reporting programs. It seems that payment programs act without regard to CIs, whereas the CMS public reporting programs are respectful of their statistical effect. I take exception to the authors when they suggest a surgeon- and specialty-specific risk-adjusted readmission rate as a solution. Surgical practice profiles vary greatly even within general surgery, such as in the subspecialties of breast, bariatrics, trauma, hepatopancreaticobiliary, transplantation, pediatrics, and so forth. Patients need condition-, disease-, and procedure-specific information tailored to their informed decision needs. Focusing on the specific procedure with “fit for purpose” performance measures will drive health care closer to sensible accountability and will best propel improvement efforts.
Published Online: October 22, 2014. doi:10.1001/jamasurg.2014.994. Conflict of Interest Disclosures: None reported.
after colorectal cancer surgery [published online October 22, 2014]. JAMA Surg. doi:10.1001 /jamasurg.2014.988.
REFERENCE 1. Lucas DJ, Ejaz A, Bischof DA, Schneider EB, Pawlik TM. Variation in readmission by hospital
JAMA Surgery December 2014 Volume 149, Number 12
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://archsurg.jamanetwork.com/ by a University of Georgia User on 06/03/2015
jamasurgery.com
