Private-Sector Readmissions for Inpatient Surgery in Veterans Health Administration Hospitals.

Area of Science:

• Health Services Research
• Surgical Quality Improvement
• Healthcare Performance Measurement

Background:

• The Veterans Health Administration (VHA) uses risk-standardized 30-day readmission rates (RSRRs) to measure surgical performance.
• Current VHA metrics often exclude readmissions occurring outside VHA facilities, potentially underestimating true readmission burdens.

Purpose of the Study:

• To assess the impact of incorporating non-VHA readmissions on the performance rankings of VHA hospitals for 30-day surgical readmissions.

Main Methods:

• A retrospective cohort study analyzed VHA and Medicare data for patients aged 65+ undergoing surgery between 2013-2019.
• Risk-standardized readmission rates were calculated using models that included VHA-only and VHA plus non-VHA readmissions.
• VHA hospitals were stratified into quintiles based on RSRRs, and changes in quintile ranking upon inclusion of non-VHA readmissions were analyzed.

Main Results:

• The study included 108,265 patients across 104 VHA hospitals; the overall 30-day readmission rate was 14.0%.
• The proportion of readmissions outside the VHA varied significantly (median 20.9%).
• Including non-VHA readmissions caused 23.1% of hospitals to improve their performance quintile and 22.1% to worsen.

Conclusions:

• VHA hospitals that improved performance rankings after including non-VHA readmissions typically had higher surgical volumes, greater complexity, and fewer external readmissions.
• The findings suggest that efforts to improve care continuity might paradoxically lead to poorer VHA performance metrics.
• Accurate assessment of VHA hospital performance necessitates comprehensive tracking of all-cause, 30-day readmissions, regardless of facility.