MedicalResearch.com Interview with:
Teryl K. Nuckols, MD
Vice Chair, Clinical Research
Director, Division of General Internal Medicine
Los Angeles, California
MedicalResearch.com: 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.