Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia

Wadhera, Rishi K.; Maddox, Karen E. Joynt; Wasfy, Jason H.; Haneuse, Sebastien; Shen, Changyu; Yeh, Robert W.

doi:10.1001/jama.2018.19232

Cited by 306 publications

(291 citation statements)

References 33 publications

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“…As supported by Wadhera and colleagues,12 a programme that appears successful by several analyses with respect to an important patient outcome such as readmission could also be harmful for patients. This study adds to a growing literature sounding the alarm for higher mortality rates27–29 associated with the HRRP.…”

Section: Discussionmentioning

confidence: 99%

“…These hospitals are at risk for a financial penalty involving each of the targeted conditions, for a current maximum overall penalty of 3% reduction in payment for all the hospital’s Medicare admissions. In this retrospective cohort study of 8.4 million hospitalisations involving Medicare beneficiaries from April 2005 to March 2015, Wadhera and colleagues12 addressed a question that has arisen in light of reduced readmissions since announcement and implementation of the HRRP: Was this programme associated with higher mortality for patients hospitalised for heart failure, acute myocardial infarction and pneumonia?…”

Section: Association Of the Hospital Readmissions Reduction Program Wmentioning

confidence: 99%

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Quality & safety in the literature: July 2019

2019

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Section: Discussionmentioning

confidence: 99%

Section: Association Of the Hospital Readmissions Reduction Program Wmentioning

confidence: 99%

Quality & safety in the literature: July 2019

2019

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“…The most significant concern is the possible negative impact of the HRRP program on mortality, specifically for heart failure. Depending on the data source, statistical methodology for studying longitudinal trends and their association with the HRRP, and level of analysis (hospital vs aggregate national results), different studies have reached discordant conclusions regarding this crucial question …”

Section: Introductionmentioning

confidence: 99%

The association of hospital teaching intensity with 30‐day postdischarge heart failure readmission and mortality rates

Shahian

Liu

Mort

et al. 2020

Health Services Research

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Objective To investigate risk‐adjusted, 30‐day postdischarge heart failure mortality and readmission rates stratified by hospital teaching intensity. Data Sources and Study Setting A total of 709 221 Medicare fee‐for‐service beneficiaries discharged from 3135 US hospitals between 1/1/2013 and 11/30/2014 with a principal diagnosis of heart failure. Study Design Hospitals were classified as Council of Teaching Hospitals and Health Systems (COTH) major teaching hospitals, non‐COTH teaching hospitals, and nonteaching hospitals. Hospital teaching status was linked with MedPAR patient data and FY2016 Hospital Readmission Reduction Program penalties. Index hospitalization survival probabilities were estimated with hierarchical logistic regression and used to stratify index hospitalization survivors into severity deciles. Decile‐specific models were estimated for 30‐day postdischarge readmission and mortality. Thirty‐day postdischarge outcomes were estimated by teaching intensity and penalty categories. Principal Findings Averaged across deciles, adjusted 30‐day COTH hospital readmission rates were, on a relative scale ([COTH minus nonteaching] ÷ nonteaching), 1.63 percent higher (95% CI: 0.89 percent, 2.25 percent) than at nonteaching hospitals, but their average adjusted 30‐day postdischarge mortality rates were 11.55 percent lower (95% CI: −13.78 percent, −9.37 percent). Penalized COTH hospitals had the highest readmission rates of all categories (23.99 percent [95% CI: 23.50 percent, 24.49 percent]) but the lowest 30‐day postdischarge mortality (8.30 percent [95% CI: 7.99 percent, 8.57 percent] vs 9.84 percent [95% CI: 9.69 percent, 9.99 percent] for nonpenalized, nonteaching hospitals). Conclusions Heart failure readmission penalties disproportionately impact major teaching hospitals and inadequately credit their better postdischarge survival.

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“…To date, there is conflicting evidence about the extent to which HRRP reduces readmission rates and recent concerns that it may harm care in other unintended ways, though the final verdict is far from certain . Nonetheless, the role of value‐based purchasing policies in health care policy seems likely to continue to grow, as alternative payment models are increasingly adopted and health care institutions are mandated to have more skin in the game.…”

mentioning

confidence: 99%