A new study from researchers at Harvard and UCLA examines a federal policy meant to reduce Medicare readmission rates to hospitals. Five years ago, the Hospital Readmission Reduction Program was introduced in effort to incentivize hospitals to reduce the readmission of Medicare patients by financially penalizing them. The study finds that while readmissions did decrease among heart failure patients, there was also an increase in mortality rates that the researchers attribute to the program.
The federal policy on hospital readmissions was implemented under the Affordable Care Act. Approximately two-thirds of U.S. hospitals are penalized financially on the basis of their 30-day readmission rates. The study concludes that an unintentional result of the Hospital Readmission Reduction Program is that patients with heart failure were harmed.
For the study, data from 115,245 Medicare patients at 416 hospitals was used as well as data from the American Heart Association’s Get with the Guidelines-Heart Failure Program. The latter is a voluntary program used by hospitals nationwide to improve quality. The study looked at the time period from January 2006 to December 2014. Researchers compared the heart failure patients’ readmissions rates 30 days after discharge and one year after discharge, mortality rates, and characteristics. They also compared characteristics of the different hospitals.
A Reverse of the Declining Death Rate
The study’s authors conclude that the federal policy on hospital readmissions is directly linked to a reversal of the declining death rate for patients with heart failure. For decades the trend had been downward and now that rate is on the rise.
Because the Hospital Readmission Reduction Program is focused exclusively on hospital utilization and not on patient outcome, it seems that patients who previously may have been readmitted for clinical reasons are now kept out. Hospitals have incentives to keep patients out for longer with the result that patient deaths have increased as readmission rates declined. The senior author of the study made the macabre observation that patients who die cannot be readmitted to the hospital.
The researchers suspect that hospitals have found ways to avoid being penalized. Common strategies include the use of observation stays instead of admitting patients, inappropriate triage for medical care, and waiting until after 30 days to readmit a patient. However, when patients are harmed because a hospital is focused more on their numbers than on patient care, it could be considered negligence.
The team is continuing their research to focus on which hospitals and their patients have been most affected. They recommend that public health programs like the Hospital Readmission Reduction Program should not only have patient outcomes and quality of care as their focus, they need to be tested in trials before being adopted nationwide.
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