Five years ago, federal policymakers introduced the Hospital Readmission Reduction Program to spur hospitals to reduce Medicare readmission rates by penalizing them if they didn't. A new analysis led by researchers at UCLA and Harvard University, however, finds that the program may be so focused on keeping some patients out of the hospital that related death rates are increasing.
In a study of 115,245 fee-for-service Medicare beneficiaries at 416 hospitals, implementation of the reduction program was indeed linked to a decrease in readmissions at 30 days after discharge and at one year after discharge among people hospitalized for heart failure. But it was also linked to an increase in mortality rates among these groups of patients.
Medicare financially penalizes about two-thirds of U.S. hospitals based on their 30-day readmission rates, but the data suggests it also emphasizes strategies that unintentionally harmed patients with heart failure.
Using data from the American Heart Association's Get With The Guidelines-Heart Failure program, a voluntary quality improvement initiative at hospitals across the country, as well as Medicare data, researchers compared heart failure patients' readmission rates, mortality rates and characteristics, along with hospital characteristics, from January 2006 through December 2014.
The findings point to a reversal in a decades-long trend of a declining death rate among patients with heart failure, one that the researchers concluded was linked to the implementation of the Hospital Readmission Reduction Program.
In a way, the declining readmission rates reflect the fact that patient deaths have increased; after all, if a patient dies, they can't be readmitted.
The researchers don't dispute that the goals of the program -- reducing the number of re-hospitalizations and decreasing the costs to the healthcare system -- are positive. But they say the policy of reducing readmissions is focused too narrowly on not readmitting patients to hospitals.
The researchers are now studying which types of hospitals and patients are most affected by the trend. Regardless, they wrote, the data support a reconsideration of the policy's use for patients with heart failure.