MedicalResearch.com Interview with:
Teryl K. Nuckols, MD
Vice Chair, Clinical Research
Director, Division of General Internal Medicine
Cedars-Sinai Medical Center
MedicalResearch.com: What is the background for this study?
Response: Healthcare policymakers have long worried that value-based payment programs unfairly penalize hospitals treating many African-American patients, which could worsen health outcomes for this group.
For example, policy experts have suspected that the Medicare Hospital Readmission Reduction Program unevenly punishes institutions caring for more vulnerable populations, including racial minorities. They’ve also feared that hospitals might be incentivized to not give patients the care they need to avoid readmissions.
The study Investigators wanted to determine whether death rates following discharges increased among African-American and white patients 65 years and older after the Medicare Hospital Readmission Reduction Program started.
MedicalResearch.com: What are the main findings?
Response: The investigators found no evidence that 30-day post-discharge mortality worsened among African-American patients after implementation of the Medicare Hospital Readmission Reduction Program.
In fact, the study showed that heart attack mortality trends improved among African-American patients. Heart failure mortality trends remained stable for this population despite a significant decline in readmissions. But the study actually saw a small increase in mortality for white heart failure patients.
MedicalResearch.com: What should readers take away from your report?
Response: Our study shows that this particular value-based payment program is not harming African-American patients in terms of mortality. But we need a larger body of literature looking at other effects of this program and other value-based payment programs on racial disparities.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Future research could assess the actual interventions hospitals are using to reduce readmissions. A lot of readmissions prevention interventions require a substantial investment of time from patients and family members. Future research could think more globally about the secondary effects of these interventions on family members who may be pulled away from their jobs to care for discharged patients.
Huckfeldt P, Escarce J, Sood N, Yang Z, Popescu I, Nuckols T. Thirty-Day Postdischarge Mortality Among Black and White Patients 65 Years and Older in the Medicare Hospital Readmissions Reduction Program. JAMA Netw Open. 2019;2(3):e190634. doi:10.1001/jamanetworkopen.2019.0634
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