Study Finds Medicare Readmissions Penalties Have Not Increased Mortality from Heart Failure Interview with:

Teryl K. Nuckols, MD Vice Chair, Clinical Research Director, Division of General Internal Medicine Cedars Sinai Los Angeles, California

Dr. Nuckols

Teryl K. Nuckols, MD
Vice Chair, Clinical Research
Director, Division of General Internal Medicine
Cedars Sinai
Los Angeles, California What is the background for this study?

Response: The Medicare Hospital Readmissions Reduction Program (HRRP) penalizes hospitals with increased 30-day readmission rates among seniors admitted with heart failure (HF).  Heart failure readmission rates declined markedly following the implementation of this policy. Two facts have raised concerns about whether the HRRP might have also inadvertently increased 30-day heart failure mortality rates.

First, before the policy was implemented, hospitals with higher heart failure readmission rates had lower 30-day HF mortality rates, suggesting that readmissions are often necessary and beneficial in this population. Second, 30-day HF mortality rose nationally after the HRRP was implemented, and the timing of the increase has suggested a possible link to the policy.

Are hospitals turning patients away, putting them at risk of death, or is the increase in heart failure mortality just a coincidence? To answer this question, we compared trends in 30-day HF mortality rates between penalized hospitals and non-penalized hospitals because 30-day HF readmissions declined much more at hospitals subject to penalties under this policy. What are the main findings?

Response: We found that increases in 30-day mortality were nearly identical at penalized and non-penalized hospitals, despite dramatically different trends in readmission rates. What should readers take away from your report? 

Response: Our findings do not support the idea that the Medicare Hospital Readmissions Reduction Program has led to an increase in mortality. What recommendations do you have for future research as a result of this work? 

Response: Future research should search for other factors that may be contributing to increasing mortality among heart failure patients shortly after hospital discharge. 

No conflicts of interest.


HF Mortality Trends Under Medicare Readmissions Reduction … – JACC

Nov 17, 2018 @ 12:11 pm

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