The federal push to reduce readmission rates may be leading to higher related death rates, according to a new study.
Researchers examined data on more than 115,000 Medicare fee-for-service beneficiaries at 416 hospitals and found that while the Hospital Readmission Reduction Program was indeed linked to reduced readmission rates for patients with heart failure, it was also linked to higher death rates for these patients.
The 30-day adjusted readmission rate declined from 20% before HRRP to 18.4% after the program was implemented, but the 30-day mortality rates increased from 7.2% to 8.6%. The pattern was similar for one-year rates, according to the study published in JAMA Cardiology; the readmission rates declined from 57.2% to 56.3%, while mortality rates increased from 31.3% to 36.3%.
The Centers for Medicare & Medicaid Services penalized half of U.S. hospitals for readmission rates this year, and many of the hospitals penalized are large teaching hospitals that are likely to admit Medicaid or Medicare patients. The penalties are controversial, and major professional organizations like the American Hospital Association have questioned the methods used to assess the data.
Gregg Fonarow, M.D., the study's senior author and co-chief of the David Geffen School of Medicine at UCLA department of cardiology, said in an announcement that the study suggests HRRP "incentivized strategies that unintentionally harmed patients with heart failure."
"The policy should focus on incentivizing improving quality and patient-centered outcomes of those with heart failure and not on a misguided utilization metric of rehospitalizations," Fonarow said.
Recent studies have also suggested that care quality improvements can cut down readmission rates, but those initiatives may not save hospitals money. In that study, readmission rates for different patient cohorts did go down, but the cost savings results fluctuated so widely that it was inconclusive as to whether or not the improvements cut costs.
The researchers said that they're now examining which patients and hospitals are most impacted by the link between HRRP and death rates. The goals of the program are positive, they said, but focusing strictly on readmissions may be too narrow.