- A study published in JAMA found no evidence that improvements in readmission rates linked with the CMS' Hospital Readmissions Reduction Program were associated with increases in in-hospital or post-discharge mortality rates among Medicare beneficiaries.
- Researchers looked at mortality rates among Medicare beneficiaries hospitalized for three conditions — acute myocardial infarction, heart-failure or pneumonia — and sought to evaluate the effects of HRRP, implemented in 2012 with the goal of reducing early readmissions following hospitalization for those common conditions
- Between 2006 and 2014, in-hospital mortality decreased from 10.4% to 9.7% for acute myocardial infarction, from 4.3% to 3.5% for heart failure and from 5.3% to 4% for pneumonia. During the same period, 30-day post-discharge mortality decreased from 7.4% to 7.0% for acute myocardial infarction, but increased from 7.4% to 9.2% for heart failure and from 7.6% to 8.6% for pneumonia. The study concludes those increases were not associated with HRRP.
For many hospitals, HRRP is a reliable mechanism for driving down high costs associated with readmissions. A report published by the New England Journal of Medicine in 2011 found that roughly one-fifth of Medicare beneficiaries discharged from a hospital were re-hospitalized within 30 days, costing the government an estimated $17.4 billion annually.
HRRP sought to curb those costs and improve care by implementing financial penalties for hospitals that have higher rates of 30-day readmission than the national average. The program resulted in what the authors of this JAMA paper called a "substantial reduction" in admissions: One 2015 study found readmission rates for the program's targeted conditions declined from 21.5% to 17.8%.
MedPAC, the congressional agency tasked with analyzing Medicare and the healthcare delivery system, recently reaffirmed what it considers the ultimate success of HRRP, but stated that it believes hospital mortality may have decreased for all conditions after the the program's implementation.
Safety net hospitals that treat a disproportionately high number of socioeconomically-disadvantaged patients, however, feel the program has been unfair to them, as those patients are more likely to suffer from post-discharge complications and be readmitted.
CMS has acknowledged how HRRP negatively impacts safety-net hospitals and, as part of the FY 2018 Inpatient Prospective Payment Systems rule, now judges hospitals on HRRP performance in comparison with other hospitals with similar populations. As a result, safety net hospitals will see a drop in readmission penalties of about 25% on average for fiscal year 2019, with some penalties being cut by half or more.
A separate HRRP study conducted by the University of Chicago and published this month in PLOS ONE found that readmission rates for patients with six conditions (including the three conditions analyzed in the JAMA study) were higher among for-profit hospitals when compared to readmission rates at nonprofit and government hospitals.