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Excess Days in Acute Care Provide More Comprehensive Picture of Hospital Performance Compared to 30-day Readmission Rates

The Excess Days in Acute Care (EDAC) measure provides a more comprehensive assessment of hospital performance compared to the 30-day readmission measure, which is currently used by the Centers for Medicare and Medicaid Services (CMS) to evaluate quality in the Hospital Readmissions Reduction Program (HRRP). Using the EDAC measure in the HRRP would change penalty status for about one-quarter of hospitals. These findings are published in Annals of Internal Medicine.

CMS currently uses 30-day readmission rates to evaluate hospital performance and to issue penalties to those that underperform. Hospitals have been penalized more than $3 billion to date under the HRRP. However, the 30-day readmission measure has increasingly been scrutinized because it provides an incomplete picture of hospital visits after discharge. In contrast, the EDAC measure captures all hospital encounters – inpatient, Emergency Department, and observation stays – that occur within 30-days of discharge and provides a more comprehensive picture of performance.

Researchers from Beth Israel Deaconess Medical Center studied more than 3,100 hospitals that participated in the HRRP in fiscal year 2019 to compare whether using the EDAC measure instead of readmissions would change hospitals’ penalty status for three conditions targeted by the HRRP. They found that one-quarter of hospitals’ penalty status would change if the EDAC measure were used instead of the readmission measure in the program. In addition, fewer small hospitals and rural hospitals would receive financial penalties if the EDAC measure were used. According to the study authors, these findings suggest that CMS should consider using the EDAC measure rather than the 30-day readmission measure to evaluate health care system performance under federal quality reporting and value-based programs.

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