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Complexity Science and the Readmission Dilemma:  Comment on “Potentially Avoidable 30-Day Hospital Readmissions in Medical Patients” and “Association of Self-reported Hospital Discharge Handoffs With 30-Day Readmissions”

Eric Marks, MD
JAMA Intern Med. 2013;173(8):629-631. doi:10.1001/jamainternmed.2013.4065.
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The increasing proliferation of articles dealing with hospital readmission is in no small part a response to the recommendations in the 2007 Medicare Payment Advisory Commission report to Congress (http:// www.medpac.gov/documents/Jun07_ EntireReport.pdf). These recommendations became the basis for the Hospital Readmissions Reduction Program in the Affordable Care Act altering the criteria for hospital payment reimbursement. Enforcement of these criteria by the Centers for Medicare & Medicaid Services reduces Medicare payments to hospitals that exceed preset all-cause readmission rates. As health care policy and aspects of care delivery are increasingly influenced by reimbursement, it is important to ensure that the attenuation of the overall health care financial burden is accomplished by research-driven improvements in the quality and safety of care that minimize the potential for unintended outcomes.

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