The Hospital Readmission Reduction Program Is Associated With Fewer Readmissions, More Deaths: Time to Reconsider

Has there been unintentional harm in the deployment of this process (5-14)? Because deaths without hospitalization favorably affect the HRRP metric, it should be considered a metric of utilization, not quality. The other side of the statistical correlation reported is that hospitals with no change or increasing 30-day readmissions rates, and thus facing greater HRRP financial penalties, had increases in 30-day post-discharge mortality. [...]with HRRP implementation nationally, 30-day risk-adjusted post-discharge mortality in Medicare beneficiaries hospitalized with HF increased from 7.9% in 2008 to 9.2% in 2014 (19). Furthermore, the HRRP has created additional financial incentives for hospitals to document more comorbid conditions and greater complexity (up-coding), which is further facilitated by electronic health records, to improve risk-adjusted rates (21). [...]it is also possible that this strategy has artificially made the reductions in risk-standardized 30-day readmission appear greater than they actually were and has artificially underestimated the increases in risk-adjusted mortality for HF that may have occurred. 3 A. Vidic, J.T. Chibnall, P.J. Hauptman, Heart failure is a major contributor to hospital readmission penalties, J Card Fail, Vol. 21, 2015, 134-137 4 P.S. Keenan, S.L. Normand, Z. Lin, An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure, Circ Cardiovasc Qual Outcomes, Vol. 1, 2008, 29-37 5 R. Bhalla, G. Kalkut, Ann Intern Med, Vol. 152, 2010, 114-117 6 E.Z. Gorodeski, R.C. Starling, E.H. Blackstone, N Engl J Med, Vol. 363, 2010, 297-298 7 K.E. Joynt, E.J. Orav, A.K. Jha, Thirty-day readmission rates for Medicare beneficiaries by race and site of care, JAMA, Vol. 305, 2011, 675-681 8 M.D. Naylor, E.T. Kurtzman, D.C. Grabowski, C. Harrington, M. McClellan, S.C. Reinhard, Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults, Health Aff (Millwood), Vol. 31, 2012, 1623-1632 9 M.J. Press, D.P. Scanlon, A.M. Ryan, Limits of readmission rates in measuring hospital quality suggest the need for added metrics, Health Aff (Millwood), Vol. 32, 2013, 1083-1091 10 K.E. Joynt, A.K. Jha, Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program, JAMA, Vol. 309, 2013, 342-343 11 M. Gilman, J.M. Hockenberry, E.K. Adams, A.S. Milstein, I.B. Wi