News: Hospital readmissions reduction program’s success questioned

The success of CMS’ Hospital Readmission Reduction Program (HRRP) has been overstated, according to a recent study from Health Affairs.

Since October 2012, the HRRP has financially penalized hospitals for high readmissions rates. HRRP started with three targeted conditions—acute myocardial infarction, heart failure, and pneumonia. In 2012, the penalty was a maximum 1% of Medicare reimbursements increasing to 2% in 2015, HealthLeaders Media reported.

While CMS and the Medicare Payment Advisory Commission (MedPAC) have both praised the HRRP’s success at lowering readmissions, the new study suggests that the declines in risk-adjusted readmission rates for the targeted conditions are 48% lower than previously reported, due to a change in the electronic transaction standards hospitals use to submit claims to Medicare, HealthLeaders Media reported.

Before 2011, healthcare providers couldn’t submit more than nine or 10 diagnosis claims for a Medicare claim. After January 2011, healthcare providers could submit claims with as many as 25 diagnosis codes. Allowing hospitals to file a larger number of diagnoses per claims reduced risk-adjusted patient readmission rates, according to the researchers.

“By coincidence, the HRRP was implemented just before a change in electronic transaction standards that increased diagnostic coding and therefore created the illusion that risk-adjusted readmission rates had decreased,” the researchers wrote.

This reduction, according to the researchers, raises concerns for both clinical care and the future of the HRRP. The reduction in readmissions was based on flawed data and therefore clinicians should be “re-examining that evidence and any subsequent knowledge that was based on [it],” Christopher Ody, PhD, a research assistant professor at Northwestern University's Kellogg School of Management in Illinois, and the lead author of the study, told HealthLeaders Media.

While the HRRP is flawed, Ody suggests that the program should remain with some necessary adjustments.

"The goal with these programs isn’t to pay good hospitals more and bad hospitals less; it is to create incentives for hospitals with worse outcomes to improve,” he told HealthLeaders Media. “These programs deserve more time to be tweaked.”

Editor’s note: This story originally appeared in HealthLeaders Media. To read the study, click here. To read about the link between readmission reductions and increased mortality, click here.