Study: CMS penalties unfair, lower readmission rates don't correlate with improved outcomes

A new study suggests penalties for excessive readmission rates of heart attack patients are unfair to hospitals that serve socioeconomically disadvantaged populations.

Since the Centers for Medicare & Medicaid Services rolled out the Hospital Readmissions Reduction Program (HRRP) in 2012, federal penalties have led to lower readmission rates. Results of a study published in JAMA Cardiology found no correlation between those lower readmission numbers and the level of care delivered, nor did they find a correlation with improved outcomes.

“The current CMS readmission metric does not correlate with long-term clinical outcomes,” said the study’s first author, Ambarish Pandey, M.D., cardiology fellow at the University of Texas Southwestern Medical Center, in an announcement accompanying the study’s publication.

The study also suggested CMS failed to make appropriate adjustments for certain relevant metrics, particularly a patient’s race or ethnicity. Despite similar metrics for one-year mortality rates and care quality across hospitals, the study noted a greater proportion of penalties for excessive readmissions at hospitals serving a disproportionate number of socioeconomically disadvantaged patients.

“It is fundamentally unfair to penalize hospitals for factors that are beyond their control,” senior author James de Lemos, M.D., professor of internal medicine the University of Texas Southwestern Medical Center, said in the announcement.

The authors also noted that penalizing hospitals with a greater proportion of disadvantaged patients, such as safety-net hospitals, becomes counterproductive when hospitals that most need resources for patient care wind up spending them on penalties for circumstances they did not create.

The authors recommend policy changes along two fronts: They support revisions to readmission metrics to better account for circumstances such as race or ethnicity, which lie outside a hospital’s control. They also suggested a need to adjust incentive policies themselves, so that they connect more directly with improved measures of care quality and patient outcomes.