Early Examination of Hospital-Level Performance on Unplanned, Potentially Avoidable Hospital Visits After Chemotherapy, 2018-2022

To assess changes in publicly reported, potentially avoidable hospital visits after chemotherapy since the introduction of a Medicare quality measure.

Retrospective analysis of avoidable emergency department (ED) and inpatient admission (ADM) rates after chemotherapy between 2018 and 2022, across absolute visit rates and relative hospital performance ("better than", "no different than", "worse than" the national rate). We stratified hospitals into quartiles of visit rates in 2018 and used this to model the change in visit rates from 2018 to 2022 with generalized linear regression.

A longitudinal cohort of hospitals from the Medicare Outpatient Quality Reporting Program.

We analyzed 1179 hospitals (94.3% non-profit, 22.9% teaching). National avoidable ED visit rates were 6.0% in 2018, 5.4% in 2022; ADM rates were 12.5% in 2018, 10.3% in 2022. Nearly all hospitals were deemed to have performed "no different" than the national rate each year in ED (≥ 95.3%) and ADM (≥ 91.1%). In adjusted analyses, visit rates for hospitals in the lowest 2018 visit rate quartiles declined the least by 2022 (ED: -0.44% 95% CI: -0.58 to -2.94; ADM: -0.91%, 95% CI: -1.14 to -0.69), and declined the most for hospitals in the highest 2018 quartiles (ED: -1.72%, 95% CI: -1.85 to -7.73; ADM: -3.03%, 95% CI: -3.27 to -2.81). We estimated that the tendency for extreme baseline values to approach the average over time accounted for up to one-tenth of the decline among the worst-performing 2018 quartiles (ED: 10.6% of rate change, 95% CI: 9.8 to 11.5; ADM: 9.0%, 95% CI: 8.2 to 9.8).

Hospitals reduced their potentially avoidable hospital visit rates, though Medicare deemed that nearly all hospitals performed "no different" than the national average each year. It remains unclear if the reductions were driven by this quality measure.