Hospital Readmission Penalties Increase Mortality Rates

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Hospital Readmission Penalties Increase Mortality Rates

Double-edged sword

By Working Nurse
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Readmission penalties have made strides in reducing hospital readmission rates, but these reimbursement penalties have also had an unintended consequence: higher mortality for heart failure patients.

More Fines, More Deaths

Federal regulations established under the Affordable Care Act now impose substantial financial penalties on hospitals that under-perform on various quality metrics, including 30-day readmission rates for certain conditions.  In fiscal 2017, 79 percent of U.S. hospitals suffered Hospital Readmission Reduction Program (HRRP) penalties, which totaled about $564 million. Data from the Centers for Medicare and Medicaid Services (CMS) suggests that the HRRP penalties have indeed reduced hospital readmission rates.

However, a recent study in the November 12 online edition of JAMA Cardiology warns that reductions in heart failure readmissions have gone hand in hand with increased patient mortality. The study compared heart failure data from 416 hospitals before and after implementation of the HRRP penalties. Although the 30-day readmission rate for heart failure fell from 20.0 to 18.4 percent, after implementation, the risk-adjusted 30-day patient mortality rate rose from 7.2 to 8.6 percent. 

Heart failure patients’ risk-adjusted one-year mortality rate climbed from 31.3 to 36.3 percent, a 16 percent increase.

Patients at Risk

Senior author Gregg Fonarow, M.D., a UCLA cardiologist and professor of cardiovascular medicine, believes these results demonstrate that the HRRP penalties have “incentivized strategies that unintentionally harmed patients with heart failure.” Coauthor Ankur Gupta, M.D., a cardiovascular research fellow at the Brigham and Women’s Hospital, Harvard Medical School, says the real impact of the readmission penalties is reduced hospital utilization, not better quality care. 

“To avoid the penalties, hospitals now have incentives to keep patients out of hospitals longer, possibly even if previously some of these patients would have been readmitted earlier for clinical reasons,” he explains. “If a patient dies, then that patient cannot be readmitted,” remarks Fonarow, who says the HRRP heart failure guidelines should be restructured to “focus on incentivizing improving quality and patient-centered outcomes.”

This article is from workingnurse.com.

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