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Financial penalties meant to reduce U.S. hospital readmissions for patients with heart failure and pneumonia may actually increase their risk of death after leaving the hospital, a new study suggests.
In 2012, the U.S. Centers for Medicare & Medicaid Services started hitting hospitals with financial penalties for higher-than-expected 30-day readmission rates for patients initially hospitalized for three conditions: heart failure, heart attack, and pneumonia.
While readmissions for those conditions have declined, doctors and policy makers have expressed concerns that the Hospital Readmissions Reduction Program (HRRP) may harm patient care and increase after-discharge death rates.
In this study, researchers examined data on more than 8 million Medicare fee-for-service hospitalizations for heart failure, heart attack or pneumonia from 2005 to 2015, to compare death rates among patients before and after introduction of the HRRP.
Even though rates of death within 30 days of leaving the hospital were “increasing among patients hospitalized for heart failure in the years before HRRP was established, we found that the rise accelerated after the policy was implemented,” said study co-corresponding author Changyu Shen. He is a senior biostatistician in the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center, in Boston.
The researchers also found that after-discharge death rates among patients with pneumonia were stable before HRRP, but rose after the program was introduced.
“Whether the HRRP is responsible for this increase in mortality requires further research, but if it is, our data suggest that the policy may have resulted in an additional 10,000 deaths among patients with heart failure and pneumonia during the five-year period after the HRRP announcement,” said Shen, who’s also an associate professor of medicine at Harvard Medical School.
According to study co-corresponding author Dr. Robert Yeh, “The implications of our findings are very important.” Yeh directs the Smith Center for Outcomes Research in Cardiology at Harvard Medical School.
“Nearly $2 billion in financial penalties have been imposed on hospitals by the HRRP since 2012, and this national policy has affected nearly all hospitals in a significant way,” he said in a Beth Israel news release.
“This is an example of how we can’t always predict the consequences of applying external incentives to medical care,” Yeh said. “It’s important that we disseminate this data while continuing to evaluate and discuss the future of policies that financially incentivize the prevention of readmissions to a greater extent than other patient-centered outcomes.”