What is the value of adding Medicare data in estimating VA hospital readmission rates?
OBJECTIVE
To determine the effects of including diagnostic and utilization data from a secondary payer on readmission rates and hospital profiles.


DATA SOURCES/STUDY SETTING
Veterans Health Administration (VA) and Medicare inpatient and outpatient administrative data for veterans discharged from 153 VA hospitals during FY 2008-2010 with a principal diagnosis of acute myocardial infarction, heart failure, or pneumonia.


STUDY DESIGN
We estimated hospital-level risk-standardized readmission rates derived using VA data only. We then used data from both VA and Medicare to reestimate readmission rates and compared hospital profiles using two methods: Hospital Compare and the CMS implementation of the Hospital Readmissions Reduction Program (HRRP).


DATA COLLECTION/EXTRACTION METHODS
Retrospective data analysis using VA hospital discharge and outpatient data matched with Medicare fee-for-service claims by scrambled Social Security numbers.


PRINCIPAL FINDINGS
Less than 2 percent of hospitals in any cohort were classified discordantly by the Hospital Compare method when using VA-only compared with VA/Medicare data. In contrast, using the HRRP method, 13 percent of hospitals had differences in whether they were flagged as having excessive readmission rates in at least one cohort.


CONCLUSIONS
Inclusion of secondary payer data may cause changes in hospital profiles, depending on the methodology used. An assessment of readmission rates should include, to the extent possible, all available information about patients' utilization of care.
["O'Brien|William J|WJ|", 'Chen|Qi|Q|', 'Mull|Hillary J|HJ|', 'Shwartz|Michael|M|', 'Borzecki|Ann M|AM|', 'Hanchate|Amresh|A|', 'Rosen|Amy K|AK|']
D000368:Aged D000369:Aged, 80 and over D014487:Centers for Medicare and Medicaid Services, U.S. D015331:Cohort Studies D005260:Female D006302:Health Services Research D006333:Heart Failure D006787:Hospitals, Veterans D006801:Humans D008297:Male D006278:Medicare D015233:Models, Statistical D009203:Myocardial Infarction D016017:Odds Ratio D010359:Patient Readmission D011014:Pneumonia D012189:Retrospective Studies D012307:Risk Factors D014481:United States
Medicare Readmissions Veterans Affairs (U.S.) public reporting quality assessment