A 2018 JAMA summary of research says, "there is now independently corroborated evidence that the HRRP [hospital readmissions reduction program] was associated with increased postdischarge mortality among patients with heart failure and new evidence that the HRRP was associated with increased mortality among patients hospitalized for pneumonia. In light of these findings, it is incumbent upon Congress and CMS to initiate an expeditious reconsideration and revision of this policy."
There is also a 2017 summary in Modern Healthcare.
Higher Deaths after the Readmission Penalties Started
A 2015 CDC study found higher death rates from heart failure after the readmission penalties started. Their data cover both hospitalized and non-hospitalized patients, so they include the effect of less hospital treatment for heart failure, driven by penalties.
A 2017 American College of Cardiology editorial said, "in 2014 alone, an estimated 5,008 excess [Heart Failure] patient deaths were associated with [readmissions program] implementation."
A 2018 JAMA study found higher death rates after the readmission penalties started, primarily in heart failure patients, and to some extent in pneumonia patients treated in hospitals. The paper's findings are strong, but the summary hides those findings: The paper says, "45-Day Postadmission Mortality... HRRP announcement was significantly associated with an increase in mortality" but the summary says, "Given the study design and the lack of significant association of
the HRRP with mortality within 45 days of admission, further research is needed." Then they refuse to say what kind of research would be more conclusive than the research so far. I asked, "Would you support removing penalties for a large random sample of hospitals for 20 years? Something else?" and they were silent.
Correlation between Low Readmissions and High Death Rates
Heidenreich et al. pubmed.gov/20650356
(2010) Journal of the American College of Cardiology, 56(5), 362-368.
Gorodeski, et al. pubmed.gov/20647209
(2010) New England Journal of Medicine, 363(3), 297-298.
American Hospital Association aha.org/research/reports/tw/11sep-tw-readmissions.pdf
(2011) Trendwatch September 2011
Krumholz et al. pubmed.gov/23403683
(2013) Journal of the American Medical Association. 2013 Feb.13; 309(6): 587–593.
Gilman et al. pubmed.gov/25092831
(2014) Health Affairs, 33, no.8 (2014):1314-1322
Deaths Caused by a Program to Avoid Readmissions:
Fan et al. pubmed.gov/22586006
(2012) Annals of Internal Medicine 2012 May 15; 156(10):673-83
Joynt et al. pubmed.gov/21325183
(2011) Journal of the American Medical Association. 2011 Feb 16;305(7):675-81
Rodriguez et al. pubmed.gov/21835285
(2011) American Heart Journal. 2011 Aug;162(2):254-261.e3
Joynt et al. pubmed.gov/23340629
(2013) Journal of the American Medical Association. 2013 Jan 23;309(4):342-3
Dr Ashish Jha, of Harvard's School of Public Health, told PBS, "If you look at, for instance, the U.S. News [and World Report] publishes its list of top 50 hospitals. Those hospitals tend to have very low infection rates, very low mortality rates, very low death rates. Guess what? They tend to have very high readmission rates, because they do such a good job of keeping their patients alive that many of them are readmitted."
Dr. Sunil Kripalani, of Vanderbilt University Medical Center told Fox News, "Among patients with heart failure, hospitals that have higher readmission rates actually have lower mortality rates. So, which would we rather have -- a hospital readmission or a death?"
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