Hospital Readmission Program Penalties Didn’t Raise Mortality Rates
Reductions in hospital readmissions associated with the financial penalties of the Hospital Readmission Reduction Program (HRRP) are not associated with higher mortality rates.
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By Jessica Kent
- The Hospital Readmission Reduction Program (HRRP) achieved a significant drop in readmission rates for Medicare patients hospitalized for pneumonia, acute myocardial infarction (AMI), and heart failure without bringing an increase of in-hospital and post discharge mortality rates, according to a study published in JAMA.
Introduced in 2010, HRRP aims to reduce readmissions after hospitalizations for common medical conditions, including pneumonia, AMI, and heart failure. HRRP created financial incentives to improve care for patients with these conditions during and after hospitalizations. As a result, readmission rates decreased markedly across the nation.
Researchers set out to find whether the reduction in readmission rates was leading to increased mortality among Medicare beneficiaries, which would indicate that patients in true need of rehospitalization were not being provided the care they needed as hospitals attempted to avoid financial impacts.
By examining Medicare data from 2006 to 2014, researchers assessed mortality during hospitalizations and within 30 days of discharge following a hospitalization for pneumonia, AMI, and heart failure.
In particular, the group observed whether trends for in-hospital or post-discharge mortality changed at the initial announcement of HRRP or at the implementation of the financial penalty phase.
The researchers found that readmission rates for all three conditions dropped during the study period.
At the same time, in-hospital mortality rates for AMI decreased from 10.4 percent to 9.7 percent, and AMI post-discharge mortality rates decreased from 7.4 percent to 7.0 percent.
For heart failure, in-hospital mortality rates fell from 4.3 percent to 3.5 percent, but post-discharge mortality rates increased from 7.4 percent to 9.2 percent.
Similarly, in-hospital mortality rates for pneumonia decreased between 2006 and 2014, but post-discharge mortality rates for this condition rose from 7.6 percent to 8.6 percent.
The results show that although post-discharge mortality rates increased for both heart failure and pneumonia, these increases began over three years before the announcement of HRRP, and five years before the implementation of the program’s penalties.
These findings significantly contrast with the results of a 2017 study published in JAMA Cardiology, which concluded that increases in post-discharge mortality rates for heart failure were the result of the value-based penalty component of HRRP.
The study stated that providers could be refusing hospitalizations because they have a financial incentive to do so.
However, the results of the 2018 study appear to refute these previous findings, although the researchers acknowledge that their investigation did have some limitations.
The group that conducted the 2018 study did not evaluate other factors that may impact mortality trends besides HRRP. Additionally, the current study doesn’t assess patterns in mortality for patients treated in outpatient settings, as these patients do not fall under the scope of HRRP.
Still, the team believes their results show that the success of HRRP has not impacted rising mortality rates for any of the three conditions.
“These findings from the overall Medicare fee-for-service population do not support an assertion that either the HRRP or its associated declines in readmission rates are associated with increasing mortality, because mortality rates either did not change or started to increase well before the HRRP passage and any decrease in readmissions,” the researchers concluded.
