ArticleCritical care medicine2015
Gaming hospital-level pneumonia 30-day mortality and readmission measures by legitimate changes to diagnostic coding.
Article in Critical care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
25 citing papers in PubMed, 48 citations in OpenAlex.
- Comparison of early treatment with ceftolozane/tazobactam versus polymyxin-based therapy of pneumonia due to MDRAntimicrobial agents and chemotherapy · 2025Observational
- Launching Financial Incentives for Physician Groups to Improve Equity of Care by Patient Race and Ethnicity.The Milbank quarterly · 2024Article
- Comparative evaluation of early treatment with ceftolozane/tazobactam versus ceftazidime/avibactam for non-COVID-19 patients with pneumonia due to multidrug-resistant Pseudomonas aeruginosa.The Journal of antimicrobial chemotherapy · 2024Article
- Incidence of acute kidney injury (AKI) and its impact on patient outcomes among adult hospitalized patients with carbapenem-resistant Gram-negative infections who received targeted treatment with a newer β-lactam or β-lactam/β-lactamase inhibitor-, polymyxin- or aminoglycoside-containing regimen.The Journal of antimicrobial chemotherapy · 2024Observational
- Diagnostic Coding Intensity among a Pneumonia Inpatient Cohort Using a Risk-Adjustment Model and Claims Data: A U.S. Population-Based Study.Diagnostics (Basel, Switzerland) · 2022Article
- Learning from Lean: a quality improvement project using a Lean-based improvement approach to improve discharge for patients with frailty in an acute care hospital.BMJ open quality · 2021Article
- Article
- Age-related incidence and outcomes of sepsis in California, 2008-2015.Journal of critical care · 2021Article
- Mortality Trends for Veterans Hospitalized With Heart Failure and Pneumonia Using Claims-Based vs Clinical Risk-Adjustment Variables.JAMA internal medicine · 2020Article
- Physician code creep after the initiation of outpatient volume control program and implications for appropriate ICD-10-CM coding.BMC health services research · 2020Observational
- Validation for using electronic health records to identify community acquired pneumonia hospitalization among people with and without HIV.Pneumonia (Nathan Qld.) · 2020Article
- Changes in coding of pneumonia and impact on the Hospital Readmission Reduction Program.Health services research · 2019Article
- Changing Heart Failure Coding Practices and Hospital Risk-Standardized Mortality Rates.Journal of cardiac failure · 2019Article
- Does VA Health Care Still Measure Up?Journal of general internal medicine · 2018Article
- Reporting of Sepsis Cases for Performance Measurement Versus for Reimbursement in New York State.Critical care medicine · 2018Observational
- Association of Coded Severity With Readmission Reduction After the Hospital Readmissions Reduction Program.JAMA internal medicine · 2018Article
- Impact of Public Reporting of 30-day Mortality on Timing of Death after Coronary Artery Bypass Graft Surgery.Anesthesiology · 2017Article
- Hospital-skilled nursing facility referral linkage reduces readmission rates among Medicare patients receiving major surgery.Surgery · 2016Article
- Emergency readmissions to paediatric surgery and urology: The impact of inappropriate coding.Annals of the Royal College of Surgeons of England · 2016Article
- Impact of Policies on the Rise in Sepsis Incidence, 2000-2010.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2016Review
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveRisk-standardized 30-day mortality and hospital readmission rates for pneumonia are increasingly being tied to hospital reimbursement to incentivize the delivery of high-quality care. Such measures may be susceptible to gaming by recoding patients with pneumonia to a primary diagnosis of sepsis or respiratory failure. We sought to determine the degree to which hospitals can game mortality or readmission measures and change their rankings by recoding patients with pneumonia. DESIGN AND
settingSimulated experimental study of 2,906 U.S. acute care hospitals with at least 25 admissions for pneumonia using 2009 Medicare data. PATIENTS: Elderly (age ≥ 65 yr) Medicare fee-for-service beneficiaries hospitalized with pneumonia. Patients eligible for recoding to sepsis or respiratory failure were those with a principal International Classification of Diseases, 9th Edition, Clinical Modification, discharge code for pneumonia and secondary codes for respiratory failure or acute organ dysfunction.
interventionsNone. MEASUREMENTS AND MAIN
resultsWe measured the number of hospitals that improved their pneumonia mortality or readmission rates after recoding eligible patients. When a sample of 100 hospitals with pneumonia mortality rates above the 50th percentile recoded all eligible patients to sepsis or respiratory failure, 90 hospitals (95% CI, 84-95) improved their mortality rate (mean improvement, 1.09%; 95% CI, 0.94-1.28%) and 41 hospitals dropped below the 50th percentile (95% CI, 33-52). When a sample of 100 hospitals with pneumonia readmission rates above the 50th percentile recoded all eligible patients, 66 hospitals (95% CI, 54-75) improved their readmission rate (mean improvement, 0.34%; 95% CI, 0.19-0.45%) and 15 hospitals (95% CI, 9-22) dropped below the 50th percentile.
conclusionsHospitals can improve apparent pneumonia mortality and readmission rates by recoding pneumonia patients. Centers for Medicare and Medicaid Services should consider changes to their methods used to calculate hospital-level pneumonia outcome measures to make them less susceptible to gaming.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.