Although there has been the concern that the reduction in hospital readmission rates may possibly result in an increase in mortality rates after discharge, a new study published by JAMA finds that among Medicare beneficiaries hospitalized for heart failure, heart attack or pneumonia, reductions in hospital 30-day readmission rates were associated with a reduction in 30-day mortality rates following discharge.
The Affordable Care Act (ACA) established the Hospital Readmissions Reduction Program, which required the Centers for Medicare & Medicaid Services to reduce payments to hospitals with higher-than-expected readmission rates for targeted conditions, including heart failure (HF), acute myocardial infarction (AMI; heart attack), and pneumonia. Whether hospitals' increased focus on lowering readmissions produced unintended consequences, particularly increased mortality after hospitalization, has not been known. Researchers and advocacy groups have raised concerns that hospitals, wary of financial penalties, might deter the readmission of patients requiring inpatient care, thereby increasing mortality after discharge.
Kumar Dharmarajan, M.D., M.B.A., of Yale New Haven Health, New Haven, Conn., and colleagues examined the correlation of trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge among Medicare fee-for-service beneficiaries 65 years or older hospitalized with HF, AMI, or pneumonia from January 2008 through December 2014. Approximately 6.7 million hospitalizations for these conditions were identified, as were any changes in risk-adjusted readmission and mortality rates.
Analysis of the data indicated that reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge. "While concerns about unintended consequences of incentivizing readmission reduction have been frequently raised, study findings strongly suggest that mortality has not increased," the authors write.
A limitation of the study was that because it included only three conditions, findings may not apply to readmission reductions for conditions not targeted by the ACA.
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Related material: The editorial, "Readmissions Have Declined, and Mortality Has Not Increased," by Karen E. Joynt Maddox, M.D., M.P.H., of Brigham and Women's Hospital, Boston, and Associate Editor, JAMA, also is available at the For The Media website.
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