News: Readmission penalties don’t negatively affect mortality outcomes, study finds

According to a recent study published in the Journal of the American Medical Association (JAMA), Medicare penalties for above-average readmission rates among patients with acute myocardial infarction (AMI), heart failure, and pneumonia do not seem to have affected mortality rates either in-hospital or after discharge, MedPage Today reported.

In the 2006-2014 period (which spans the Hospital Readmission Reduction Program’s [HRRP] rollout during 2010-2012), in-hospital mortality rates decreased among Medicare beneficiaries hospitalized for AMI (from 10.4% to 9.7%), heart failure (4.3% to 3.5%), and pneumonia (5.3% to 4.0%).

Rates of 30-day post-discharge mortality for AMI patients also fell from 10.4% to 9.7%. The 30-day post-discharge mortality rates for heart failure and pneumonia, however, increased from 7.4% to 9.2% and 7.6% to 8.6%, respectively, according to MedPage Today.

The researchers argued, however, that the readmission penalties were not a factor in the increased mortality rates.

“While post-discharge mortality for heart failure and pneumonia rose over the study period, these increases began in 2007 and 2006, respectively, over three years before the announcement of the HRRP and five years before the implementation of its associated financial penalties,” the researchers wrote.

According to Ashish Jha, MD, MPH, of Harvard Global Health Institute in Cambridge, Massachusetts, in an accompanying commentary, the study brings forth two needed changes to the HRRP.

First, there needs to be an adjustment in the financial penalties for centers with more readmissions, MedPage Today reported.

“Right now, a high-readmission, low-mortality hospital will be penalized at 6 to 10 times the rate of a low-readmission, high-mortality hospital,” Jha wrote. “The signal from policy makers is clear—readmissions matter a lot more than mortality—and this signal needs to stop.”

Additionally, Jha argues that the study illuminates the need for a comprehensive examination of the HRRP, focusing on whether it has made patients better off and how many lives it has actually saved.

Editor’s note: To read MedPage Today’s coverage of this story, click here. To read the complete study from JAMA, click here. To read Jha’s commentary, click here. To read about an October 2017 study of the relationship between readmissions and mortality rates, click here.