Association of US Centers for Medicare and Medicaid Services Hospital 30-Day Risk-Standardized Readmission Metric With Care Quality and Outcomes After Acute Myocardial Infarction

Abstract

During the first cycle of the Hospital Readmissions Reduction Program, participating hospitals' risk-adjusted 30-day readmission rates following MI were not associated with in-hospital quality of MI care or clinical outcomes occurring after the first 30 days after discharge.

The prevalence of 30‐day readmission after acute myocardial infarction: A systematic review and meta‐analysis

“…3 Therefore, reducing the rates of rehospitalization has attracted attention from policymakers and medical workers as a way improve the quality of care and reduce costs, payment incentives and Medicare hospital readmission penalties were created to reduce readmission rates. 4,5 Beginning in year 2013, the Hospital Readmission Reduction Program (HRRP) was carried out by the US Centers for Medicare& Medicaid Services (CMS) to improve financial incentives for decreasing readmission, which hospitals received penalizing according to higher-than-expected risk-standardized 30-day readmission rates for heart failure, myocardial infarction, and pneumonia. 5 Re-hospitalization is a frequent negative outcome for both hospitals and patients, and is an enormous economic burden to the Medicare beneficiaries and private payer.…”

The heart failure readmission quagmire: taking a deep dive to find solutions

“…Although recent work has demonstrated that the overall quality of hospital care may be an important contributor to 30-day readmission rates independently of patient-level factors, 4 objective measures of care practices that adequately quantify care quality factors relevant to readmission have remained elusive. 5,6 Further, recent studies have demonstrated no consistent association between hospital-level readmission rates and 30-day or long-term risk-standardized mortality rates. 6,7 Finally, despite early gains with legislative action, readmission rates have remained nearly unchanged over several years.…”

“…The hospitals that substantially exceed average readmission rates over a calendar year are identified and incur financial penalties. 5,6 The enactment of these health care policies has been followed by improvements in rates of readmission. 1 However, several aspects of readmission after HF hospitalization remain poorly understood.…”

“…However, it is unclear how these observations translate to a hospital level, particularly as prior studies have shown these two outcomes to be independent. 5,6 Although the current study 9 adds to our understanding of readmission for HF at the patient level, translating this understanding to the health care system level to improve quality of care and outcomes would require additional work. Specifically, although understanding the clinical predictors of readmission is important for identifying patients at higher risk, the capture of non-traditional risk factors that may influence risk for readmission requires the modification of systems of care.…”

Early Readmissions After ST‐Segment–Elevation Myocardial Infarction: Glass Ceiling or Room for Improvement?

“…These are known complications of STEMI treatment that may lead to unplanned, early readmissions. Furthermore, the National Cardiovascular Data Registry study of patients presenting with AMI at sites participating in the first cycle of the HRRP demonstrated that the 30‐day readmission rates were not associated with in‐hospital quality of care, as defined by adherence to performance measures 7. These considerations suggest that further refinement in quality of care during STEMI hospitalization may not translate to further reductions in readmissions, and, therefore, 30‐day readmissions should continue to be a focus of investigation but not necessarily added to the AMI performance and quality metrics 3…”