Asthma Plans Shouldn’t Affect Payments, Study Finds

A common measure of how well hospitals treat children and teens with asthma is statistically meaningless and shouldn’t be used to determine federal quality payments under the health-care law, a study found.

Discharging patients ages 2 to 17 with a home-management plan for treating the condition doesn’t reduce readmissions or emergency room use, researchers led by Rustin Morse, medical director of quality at the Phoenix Children’s Hospital, wrote today in the Journal of the American Medical Association.

The 2010 health-care law cuts government payments to operators by $155 billion in a decade and reallocates $850 million in fiscal 2013 to facilities that meet U.S. quality standards. The Joint Commission, based in Oakbrook Terrace, Illinois, determines standards used to accredit more than 19,000 health-care organizations.

“Measurement can play a key role in helping redress the shortcomings of the U.S. health-care system, but measures must meet high standards,” Charles Homer, president and chief executive officer of the National Initiative for Children’s Health Care Quality in Boston, wrote in an accompanying editorial.

Home-management plans are one of three quality measures for treating chronic disease of the lungs, a condition that affects an estimated 20 million Americans, according to the Asthma and Allergy Foundation of America, in Landover, Maryland. The others are administering medicines that relax muscles and corticosteroids that reduce inflammation.

Value of Surveillance

Homer, who also is an associate clinical professor of pediatrics at Harvard Medical School in Boston, said the study highlights the “great value of post-marketing surveillance of performance measures.”

The study examined data from 37,267 patients admitted to 30 children’s hospitals from Jan. 1, 2008, to Sept. 30, 2010. Patients’ conditions were followed for as long as 90 days.

Home-management plans had no effect on whether patients were readmitted or needed emergency care, the study concluded. Mean emergency-room use rate was 11 percent and the mean hospital readmission rate was 7.6 percent after 90 days, the study showed.

Use of reliever medications that relax muscles and corticosteroids remained high throughout the study, a sign that hospitals may no longer need to collect data on compliance with these measures, according to the study.

Relying on data from children’s hospitals where patients get better care may have skewed the study results, the authors wrote.

(Corrects name in sixth paragraph.)
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