Hospital readmission policy did not increase patients' mortality risk

The Affordable Care Act program intended to reduce the risk of patients being readmitted after hospitalizations for heart attacks, heart failure, and pneumonia has not caused an increase in mortality risk for patients in emergency departments or observational units, finds a new report in The BMJ.

The program -- formally called the U.S. Hospital Readmissions Reduction Program -- penalizes hospitals with higher than average readmission rates, and has led to national efforts to reduce the number of patients being readmitted to hospitals.

Critics had warned that the program might incentivize hospitals to send home some people who need to be admitted a second time, increasing their risk of dying.

WHAT'S THE IMPACT

The new study evaluated trends in patient mortality from the time of the readmission program's announcement through its implementation. It found no evidence of an increase in death associated with the program. In particular, among those seen in the emergency department or admitted to an observation ward (and not subsequently re-hospitalized), there was no evidence of an increase in the death rate over time.

Overall this supports the notion that the readmission policy is safe and not increasing the risk of death by turning away patients in need of rehospitalization.

The study revealed that there is a national trend toward increased risk of death in the post-discharge period for patients with heart failure, but that the increase began prior to the announcement of the ACA readmission policy.

The mechanism for the increase in mortality is yet unknown, but the trend is concurrent with a decrease in in-hospital mortality and an increase in discharges straight to hospice facilities. Nearly half of the heart patients who died after leaving the hospital were patients that hospitals had discharged directly to hospice.

THE LARGER TREND

The decline in hospital readmission rates that occurred following the launch of HRRP has been lauded as proof of the program's effectiveness, but a November analysis led by researchers at Harvard Medical School offers an alternative explanation for the outcome.

The findings suggest that an overall decline in hospital admissions may have driven the observed drop in readmissions attributed to HRRP. What looked like achievements of the program may have been a byproduct of factors driving a broader decrease in hospitalizations across the board.

HRRP was established as part of the Affordable Care Act in 2010 in an attempt to improve quality of care through payment incentives. When the same person is admitted to a hospital twice within 30 days, that might mean that the hospital is not doing enough to ensure safe discharges and adequate follow-up. Under the program, hospitals with higher-than-expected readmission rates are penalized.

Since the program launched, readmission rates progressively declined from 17.5% in 2009 to 15.5% in 2014.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com