Hospital Readmission by Method of Data Collection Elizabeth M Hechenbleikner, MD, Martin A Makary, MD, MPH, FACS, Daniel V Samarov, PhD, Jennifer L Bennett, BA, Susan L Gearhart, MD, FACS, Jonathan E Efron, MD, FACS, Elizabeth C Wick, MD, FACS BACKGROUND: Hospital readmissions are increasingly used to pay hospitals differently. We hypothesized that readmission rates, readmissions related to index admission, and potentially unnecessary read- missions vary by data collection method for surgical patients. STUDY DESIGN: Using 3 different data collection methods, we compared 30-day unplanned readmission rates and potentially unnecessary readmissions among colorectal surgery patients at a single institution between July 2009 and November 2011. We compared the NSQIP clinical reviewer method, the University HealthSystem Consortium (UHC) administrative billing data method, and physician medical record review. RESULTS: Seven hundred and thirty-five colorectal surgery patients were identified with readmission rates as follows: NSQIP 14.6% (107 of 735) vs UHC 17.6% (129 of 735). The NSQIP method identified 9 readmissions not found in billing records because the readmission occurred at another hospital (n ¼ 7) or due to a discrepancy in definition (n ¼ 2). The UHC method identified 31 readmissions not identified by NSQIP because of a broader readmission definition (n ¼ 20) or were missed by reviewers (n ¼ 11). The NSQIP method identified 72% of readmissions as related to index admission and physician chart review identified 83%. The UHC method identified 51% of readmissions as related to index admission and physician chart review identified 86%. Sixty-six of 129 UHC readmissions (51%) were deemed potentially preventable; based on physician chart review, 112 of 129 readmissions (87%) were deemed clinically necessary at the time of presentation. Most readmissions were due to surgical site infections (46 of 129 [36%]) and dehydration (30 of 129 [23%]). With improved patient-care efforts, 41 of 129 (31.8%) complications might not have required readmission. CONCLUSIONS: Readmission rates and unnecessary readmissions vary depending on data collection method- ology. Reimbursements based on readmission should use standardized and fair methods to minimize perverse incentives that penalize hospitals for appropriate care of high-risk surgical patients. (J Am Coll Surg 2013;216:1150e1158. Ó 2013 by the American College of Surgeons) The Medicare Payment Advisory Commission reported that 17.6% of index hospital admissions are associated with a readmission within 30 days of discharge. The Medi- care Payment Advisory Commission has several definitions for potentially preventable readmissions, including those that could have been avoided with improved index hospi- talization patient care, discharge planning, or outpatient care coordination. 1 Currently, there is no consensus on the best methodology for establishing potentially prevent- able readmissions and, by default, pay-for-performance incentives are beginning to use all-cause readmission rates. Starting in October 2012, two thirds of US hospitals were penalized for high all-cause readmission rates among patients with index admissions for acute myocardial infarc- tion, heart failure, and pneumonia. 2 In total, it is predicted that hospitals will forfeit about $280 million in Medicare funds. This is likely to be extended to a hospital wide all- cause unplanned readmission measure starting in 2013. Although measuring quality is an important goal, surgical patients can be different from medical patients. In a large study of Medicare beneficiaries, most 30-day Disclosure Information: Nothing to disclose. Presented at the Annual Meeting of the Maryland Chapter of the American College of Surgeons and the Annual Meeting, Resident Research Forum, Baltimore, MD, November 2012. Received November 23, 2012; Revised January 10, 2013; Accepted January 25, 2013. From the Department of Surgery, Johns Hopkins University, Baltimore (Hechenbleikner, Makary, Bennett, Gearhart, Efron, Wick) and National Institute of Standards and Technology, Gaithersburg (Samarov), MD. Correspondence address: Elizabeth C Wick, MD, FACS, Department of Surgery, Johns Hopkins University School of Medicine, Blalock Room 658, 600 N Wolfe St, Baltimore, MD 21287. email: ewick1@jhmi.edu 1150 ª 2013 by the American College of Surgeons ISSN 1072-7515/13/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jamcollsurg.2013.01.057