Incentives to reduce readmissions as part of The Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) can potentially encourage inappropriate care strategies and may adversely affect patient outcomes, according to researchers from Ronald Reagan-UCLA Medical Center, Los Angeles.
Their observational study published in JAMA Cardiology found that implementation of a program designed to reduce hospital readmissions was associated with a reduction in the rate of readmissions, but also an increase in the rate of death among Medicare patients hospitalized with heart failure.
Researchers analyzed risk of hospital readmission or death 30 days and one year after discharge for 115,245 fee-for-service Medicare patients from 416 hospital sites. Data from January 2006 through December 2014 was divided into periods before (January 1, 2006 to March 31, 2010), during (April 1, 2010 to September 30, 2012) and after HRRP penalties went into effect (October 1, 2012 to December 31, 2014).
According to results, the readmission percentages were as follows:
- The 30-day risk-adjusted readmission rate declined from 20.0% before the HRRP implementation to 18.4% in the HRRP penalties phase
- The 30-day risk-adjusted mortality rate increased from 7.2% before the HRRP implementation to 8.6% in the HRRP penalties phase
- The 1-year risk-adjusted readmission rate declined from 57.2% (before) to 56.3% (after, HRRP implementation)
- The 1-year risk-adjusted mortality rate increased from 31.3% (before) to 36.3% (after, HRRP implementation)
These findings raise concerns that the HRRP, while achieving desired reductions in readmissions, may be associated with compromised survival of patients with heart failure, the authors concluded. If the findings are confirmed they may require reconsideration of use of the HRRP penalties program for patients with heart failure.