Study Data Support Efficacy of US Hospital Readmissions Reduction Program

The US Hospital Readmissions Reduction Program (HRRP) has successfully reduced readmission rates for certain conditions and is not associated with increased risk for in-hospital or postdischarge mortality, according to study data published in JAMA Network Open.¹

First introduced in 2010, the HRRP sought to reduce early readmissions for acute myocardial infarction, heart failure, and pneumonia by instituting penalties for hospitals that exceeded the national readmission averages for these conditions.² The implementation of HRRP was associated with subsequent “substantial reduction[s]” in readmissions across the United States.³ However, criticism has been leveraged against the initiative, with concerns that associated hospitals may have adopted care strategies that increase mortality risk for these conditions.

To investigate these concerns, researchers accessed hospitalization records for Medicare beneficiaries age 65 years or older who received inpatient treatment for acute myocardial infarction, heart failure, or pneumonia between January 2006 and December 2014. In-hospital and 30-day postdischarge all-cause mortality were captured as primary outcome measures.

Researchers accessed a total of 9.2 million hospitalization records: 1.7 million for acute myocardial infarction, 4 million for heart failure, and 3.5 million for pneumonia among fee-for-service Medicare beneficiaries between 2006 and 2014. Throughout the study, risk-adjusted in-hospital mortality rate decreased substantially for all 3 conditions: acute myocardial infarction from 10.4% to 9.7%; heart failure, from 4.3%to 3.5%; and pneumonia, from 5.3% to 4.0%. Thirty-day postdischarge mortality also decreased from 7.4% to 7% for acute myocardial infarction (P <.001) but increased from 7.4% to 9.2% for heart failure and from 7.6% to 8.6% for pneumonia (both P <.001).

Among hospitalized people with heart failure and pneumonia, however, positive trends in monthly postdischarge mortality had been observed since 2007, prior to the HRRP announcement. This trend is corroborated by prior studies.⁴ Additionally, following HRRP implementation, no significant slope inflections were observed for 30-day postdischarge mortality for any condition (P >.05 for all). As such, researchers concluded that while HRRP had significant effects on readmission rates for all 3 conditions, it did not affect in-hospital or postdischarge mortality risk.

These data highlight the efficacy of HRRP on reducing hospital readmission rates for common conditions. Further research is necessary to examine the long-term impact of such policy changes on additional health outcomes in Medicare beneficiaries.

References

1. Khera R, Dharmarajan K, Wang Y, et al. Association of the Hospital Readmissions Reduction Program with mortality during and after hospitalization for acute myocardial infarction, heart failure, and pneumonia. JAMA Netw Open. 2018;1(5)e182777.
2. McIlvennan CK, Eapen ZJ, Allen LA. Hospital readmissions reduction program. Circulation. 2015;131(20):1796-1803.
3. Zuckerman RB, Sheingold SH, Orav EJ, Ruhter J, Epstein AM. Readmissions, observation, and the hospital readmissions reduction program. N Engl J Med. 2016;374(16):1543-1551.
4. Suter LG, Li SX, Grady JN, et al. National patterns of risk-standardized mortality and readmission after hospitalization for acute myocardial infarction, heart failure, and pneumonia: update on publicly reported outcomes measures based on the 2013 release. J Gen Intern Med. 2014;29(10):1333-1340.