Reducing hospital readmissions not associated with increased risk of death, study finds
- A new study published in JAMA suggests the reduction in hospital readmission rates does not increase — and may reduce —mortality after discharge.
- Kumar Dharmarajan and colleagues at Yale New Have Health examined 30-day readmission rates and 30-day post-discharge mortality rates among Medicare fee-for-service beneficiaries 65 years old and older hospitalized with heart failure, heart attack or pneumonia between January 2008 and December 2014 and found a small but significant dip in mortality rates.
- “While concerns about unintended consequences of incentivizing readmission reduction have been frequently raised, study findings strongly suggest that mortality has not increased,” the researchers write.
Under the ACA-mandated Hospital Readmissions Reduction Program, CMS reduces payments to hospitals with higher-than-expected 30-day readmission rates for heart failure, heart attack and pneumonia. Critics of the program have worried hospitals’ focus on avoiding penalties could cause them to delay readmitting patients who need inpatient care, causing them harm patients or even death.
In a editorial in the same issue of JAMA, Karen Joynt Maddox of Washington University School of Medicine praised the study’s attempt to look at unintended consequences.
“Policy changes such as the HRRP are national, far-reaching experiments, often based on little prior pilot data with which to forecast their eventual effect,” she wrote. “Evaluating such programs without concurrently evaluating unintended consequences would be like judging the success of a new anticoagulant based solely on its efficacy for deep vein thrombosis prevention and not measuring its effects on major bleeding. Similarly, policy analyses that assess only benefits without considering harms are incomplete and potentially dangerous.”
One limitation of the study is that it just looked at three conditions, so it is unclear if the results would be the same for conditions not targeted by the ACA, according to the authors.
Hospitals are eager to lower their readmission rates and not incur CMS penalties. Research has shown that hospitals that participate in voluntary value-based programs have fewer readmissions than those that rely on financial incentives alone to curb high rates. For example, participation in an accountable care organization resulted a 2.1% reduction in annual readmissions, while hospitals that participated in an ACO or meaningful use plus bundled payments had 2.6% and 2.5% fewer readmissions, respectively.
A recent Cedars-Sinai study also found an association between hospitals with quality improvement programs and lower readmission rates, though the change did not result in consistent savings for the institutions. The interventions that yielded the best most savings were those that engaged patients and caregivers in understanding post-discharge care issues.