Study raises concerns about mortality risks in readmissions penalty program
- While the CMS’ 30-day hospital readmissions penalty program has reduced heart failure readmissions, the mortality rate in that group has gone up, a new study in JAMA Cardiology concludes.
- The researchers analyzed data from 115,245 Medicare patients hospitalized for heart failure between 2006 and 2014 to see how readmissions compared before the 2010 Affordable Care Act and after implementation of the Hospital Readmissions Reduction Program (HRRP) in 2012.
- They found readmissions within 30 days dropped from 20% before the law to 18.4% after HRRP took effect. However, mortality rates rose — from 7.2% to 8.6%, or 5,400 more deaths annually.
Researchers said there could be a few reasons policies directed at reducing readmission rates could have the unintended consequence of increasing mortality rates. For one, hospitals may try to game the system with tactics like increasing observation stays, delaying admissions or shifting care to emergency departments. Also, safety net hospitals and others that are more financially strapped could find the penalties for high readmission rates hinder they're ability to provide the best care for difficult patient populations.
Regardless, the policy may need to be reexamined, the authors said. “These findings support the possibility that the Hospital Readmissions Reduction Program has had the unintended consequence of increased mortality in patients hospitalized with heart failure,” they said. Further confirmation may warrant reconsideration of the HRRP in heart failure, the researchers add.
In contrast, a study published earlier this year in JAMA found that reducing hospital readmission rates does not increase — and may in fact lower— deaths after discharge.
Under the HRRP, Medicare docks hospitals up to 3% of normal reimbursement if they have higher-than-expected 30-day readmission rates for six conditions: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, hip/knee replacement and coronary artery bypass graft surgery.
According to the CMS, about 565,000 readmissions have been avoided since 2010 as a result of the penalty program and independent readmissions reduction efforts by hospitals. But the program comes at a toll for hospitals: a total of 2,573 face reimbursement cuts in fiscal year 2018, on a par with last year.
Critics have questioned how far hospitals can go in reducing readmissions, and how the penalties are assessed.
“We know that the right rate of readmissions for patients is not necessarily zero, Akin Demehin, director of policy at the American Hospital Association, told Healthcare Dive in September. “There will always be a subset of patients who, for clinical reasons, need to come back to the hospital because that this the safest and highest quality of care for them.”
One study found that hospitals participating in voluntary value-based programs, such as an accountable care organization, have fewer readmissions than those relying on financial incentives alone to cut high rates. The researchers did not look at rates of mortality as readmissions declined.