Hospital Readmissions Reduction Program Linked To Increased Patient Deaths

Although hospital readmission programs are designed to reduce the risk of patients returning to the hospital shortly after they are discharged, new research suggests that the reduction programs may actually be increasing the number of deaths among individuals suffering from certain conditions. 

In a study published last week in the Journal of the American Medical Association (JAMA), Harvard researchers found that patients discharged for heart failure and pneumonia complications had a significantly higher post-discharge mortality rate after a hospital readmission reduction program was implemented.

In 2012, the Affordable Care Act required Centers for Medicare and Medicaid to impose financial penalties on hospitals with higher-than-expected 30-day readmission rates for patients hospitalized with either heart failure, heart attacks, or pneumonia. The program was intended to save money and deter hospitals from taking advantage of federal and state funded healthcare programs. However, researchers indicate that the program may have a corresponding negative outcome for patients discharged with heart failure and pneumonia.

Researchers reviewed more than 8.3 million hospitalizations involving Medicare and Medicaid recipients diagnosed with heart failure, pneumonia and myocardial infarction from 2005 through 2015, to determine if there was an increase in post-discharge mortality rates.

Study data indicates there were 3.2 million hospitalizations for heart failure, 1.8 million for acute myocardial infarction (AMI), and 3 million for pneumonia and, overall, there were 270,517 deaths from heart failure, 128,088 deaths from acute myocardial infarction, and 246,154 deaths from pneumonia within 30 days of discharge.

When comparing mortality rates among the populations discharged from hospitals for one of the conditions pre-HRRP and post-HRRP announcement, researchers discovered roughly 10,000 more deaths from pneumonia and heart failure patients. Patients diagnosed with heart attacks were also found to have an increased mortality rate, however, not as significant as the other conditions.

The study also indicates that after-discharge death rates among patients with pneumonia were stable before HRRP, but began to rise after the program was introduced.

Researchers warned that hospitals may be denying patients life-saving care out of fear of being penalized. Nearly $2 billion in financial penalties have been imposed of hospitals since HRRP was implemented in 2012.

“Among Medicare beneficiaries, the HRRP was significantly associated with an increase in 30-day postdischarge mortality after hospitalization for HF and pneumonia, but not for AMI,” the researchers concluded. “Given the study design and the lack of significant association of the HRRP with mortality within 45 days of admission, further research is needed to understand whether the increase in 30-day postdischarge mortality is a result of the policy.”