New measures that look at the quality of care provided by hospitals to stroke patients may wind up negatively affecting stroke care, the American Heart Association/American Stroke Association said in a statement on Wednesday.
The stroke outcome measures, which profile hospital performance for Medicare and Medicaid beneficiaries, look at whether patients die or were readmitted to the hospital within 30 days. But they do not consider the stroke’s severity, even though that determination is essential to outcomes, said the AHA.
One chief issue is that the new measures don’t accurately apply risk-adjustment in the 30-day outcome measures in patients with ischemic stroke, which is caused by a blockage in a blood vessel in or near the brain, the AHA said.
Risk adjustment is the statistical process of determining appropriate costs to healthcare plans based on risk profiles of patients sharing similar characteristics. Medical insurance plans use risk adjustment to determine how much they will reimburse hospitals for the care they provide.
The AHA expressed concerns about the metrics throughout the development and comment period on the measures. The information will be publically reported in 2014 and eventually used to determine hospital reimbursement.
The AHA said that hospitals caring for stroke patients should use a consistent standardized risk adjustment model that can ensure the reliability and the accuracy of assessing severity after stroke.
Without that, advocates fear that hospitals will avoid sicker patients because of the possibility they won’t be reimbursed adequately or will be penalized if the patients die or are readmitted within 30 days.
“We recognize that revising measures will take time; however, unintended consequences could occur from the use of these measures in their current form,” the statement reads.
The measures could also produce different rankings of hospital performance. Hospitals that admit patients who have had the most severe strokes will be penalized if the patients die or are readmitted within 30 days.
AHA will continue working with CMS to revise the measures to account for stroke severity, the organization said.