I recall reading an elegant study of hospital readmission rates, done by Cleveland Clinic a few years ago, which emphasized the foolishness of using broad criteria to determine quality. Hospitals were (and still are) graded on 30 day readmission rates. Cleveland Clinic was looking bad, based on readmissions for their cardiac patients. The study disclosed that the type of patient being readmitted to Cleveland Clinic was not surviving to be discharged in comparable hospitals. So the high readmission rate was actually a quality indicator in this instance.

Which points out a very important background issue in all these "value-based" criteria -- they are all about saving money. Raising quality is just a smoke screen. Does anyone want to bet that, if something more expensive though safer for patients would increase quality, such as breast MRI instead of x-ray mammography, it sure won't show up in any of these guidelines.

John
Internal Medicine