Hospital Readmission as a Transcatheter Aortic Valve Replacement Performance Measure

Rising healthcare costs and the identification of high-risk patients who are frequent consumers of healthcare resources have forced a spotlight on 30-day readmission rates as a key quality metric by the Centers for Medicare and Medicaid Services. This metric has quickly gained the attention of hospital systems, which are subject to penalties for higher than expected readmission rates. Several disease processes have been tracked through the Affordable Care Act’s Hospital Readmissions Reduction Program, including acute myocardial infarction, congestive heart failure, chronic obstructive pulmonary disease, and pneumonia.1 The extensive efforts to define, track, and reduce readmission rates coupled with complex payment adjustment formulas have all been aimed at improving healthcare efficiency, quality, and value of care delivered.See Article by Kolte et al Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis has become the treatment of choice for patients at high or prohibitive risk from traditional surgical valve replacement. Although a continuously growing body of data has focused on important short- and longer-term clinical outcomes, increasingly important aspects of the procedure include processes of care, clinical pathways, and patient-centered outcomes. In this issue of Circulation: Cardiovascular Interventions , Kolte et al2 used the Nationwide Readmissions Database to characterize the incidence, predictors, causes, and cost of 30-day TAVR readmission rates. The authors found that in 12 221 index TAVRs performed at 210 centers in 2013, the primary outcome of 30-day all-cause readmission rate was 17.9%.2 Based on this rate, the authors propose that readmission rates after TAVR should become a performance measure; however, several issues need to be considered before hospitals are subjected to another metric that potentially carries a financial risk.Performance measures are aspects of quality that may comprise structure, process, or outcomes. To be valid, a performance measure must represent a meaningful metric to patients and …