July 28, 2017

Study: Readmission reduction under ACA program isn't associated with increased risk of death

Daily Briefing

    Efforts to curb readmissions under the Affordable Care Act (ACA) did not increase the risk of death after discharge for heart attack, heart failure, and pneumonia patients, according to a recent study published in JAMA.

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    The ACA's Hospital Readmissions Reduction Program (HRRP), implemented in 2012, aims to reduce the number of patients who are readmitted to the hospital within 30 days of discharge for several conditions.

    Study details

    For the study, researchers investigated whether those changes unintentionally increased morality rates after discharge. To do so, they looked at the 30-day risk-adjusted readmission rates and 30-day risk-adjusted mortality rates, after discharge, for Medicare beneficiaries who were hospitalized for a heart attack, heart failure, or pneumonia between 2008 and 2014 across more than 5,000 hospitals. According to the researchers, over the course of the study period, there were:

    • 2.96 million Medicare beneficiary hospitalizations for heart failure;
    • 2.5 million Medicare beneficiary hospitalizations for pneumonia; and
    • 1.3 million Medicare beneficiary hospitalizations for heart attack.

    Findings

    The researchers found that monthly hospital 30-day readmission rates fell slightly for all three conditions, while monthly 30-day risk-adjusted mortality rates saw slight declines for heart attack and pneumonia. The researchers found monthly 30-day risk-adjusted mortality rates for heart failure rose slightly.

    The researchers wrote that the drop in 30-day readmission rates were "weakly but significantly" associated with reductions in the 30-day mortality rate post-discharge. Moreover, they found that hospitals whose readmission rates had dropped the most were more likely to reduce mortality post-hospitalization, even among heart failure patients.

    Discussion

    In an accompanying editorial, Karen Joynt Maddox of the Washington University School of Medicine wrote that the results are "certainly good news." She added, "These strategies are patient centered and, when successful, should be adopted by all hospitals, regardless of baseline readmission rates. The fact that these strategies do not inadvertently increase mortality rates, and may even have some positive effects, is even more reason to continue this important work helping patients transition safely from hospital to home."

    Writing for NPR's "Shots," Kumar Dharmarajan—study co-author and a cardiologist, geriatrician, and chief science officer at Clover Health—and Kumar Dharmarajan—study co-author and a cardiologist, geriatrician, and chief science officer at Clover Health—hypothesized that the improved mortality rates could stem from hospital's efforts to curb readmissions by "better prepar[ing] patients and families for discharge and improv[ing] the integration and coordination of care from hospital to home." They added, "These better outcomes came about not from new medicines or devices, but from a willingness of hospitals and health care professionals to engage with patients and families to promote truly patient-centered, high-quality care."

    But the researchers said there was "more work to do to further reduce readmissions," such as "recalculating penalties to include hospital-wide readmission rates," as opposed to the readmission rates for a few select conditions. "Beyond this we could encourage teamwork among the nation's health systems by minimizing or even halting the use of penalties if patient outcomes improve nationwide," the researchers added (Zimmerman, Becker's Hospital Review, 7/18; Dharmarajan/Krumholz, "Shots," NPR, 7/18; Brooks, Medscape, 7/18).

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    Reducing your hospital's readmission rates can seem like an overwhelming task—but it doesn't have to be. Knowing where to focus is half the battle. We've found that the best strategies target four stages of care with significant potential to influence patient outcomes. The other half is knowing what improvements to make.

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      Stage 4:  Transitional care support

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