Are 30-Day Readmission Rules Deadly for Patients?

Leigh Page

Disclosures

September 03, 2019

"Gaming is possible, but we have yet to see a specific case identified," he says.

Krumholz says people tell him about gaming, but when he asks for more details, "they say they weren't there. There are no doctors who say that they ever have done it or have even observed it. That could be interpreted as them standing by and doing nothing."

However, critics of the program, such as Wadhera, think a great deal of HRRP gaming is going on, although Wadhera couldn't provide specific examples except for the anonymous reports on the Times site.

"Instead of investing in improvements in care transitions and postdischarge care, which is difficult and expensive, many hospitals have found other ways to make their readmission rates appear lower," Wadhera says.

Pros of the HRRP

Supporters of the readmissions program, which started in 2012, think the goal of the program is a positive one.

They say hospitals have responded to the program by improving their discharge planning and reaching out to discharged patients to make sure they stay healthy and don't return to the hospital.

Research studies by Krumholz's team and others show that the program has reduced readmissions without significantly raising mortality. Indeed, some consider the HRRP one of the most successful value-based payment programs, under which hospitals and physicians are paid on the basis of improved health outcomes, with the goal of saving money for the healthcare system.

HRRP began 7 years ago by targeting three conditions: heart failure, acute myocardial infarction, and pneumonia. Three more conditions were subsequently added: chronic obstructive pulmonary disease, elective hip and knee replacement, and coronary artery bypass graft. More additions are expected in the future.

There were high expectations for HRRP. MedPAC once estimated that hospitals could prevent 80% of readmissions, whereas other estimates put the figure as low as 10%.

The actual reduction in readmissions, however, was far less than the estimates. A 2017 report indicated a reduction of 3.7 percentage points, from 21.5% to 17.8%, with most of the reduction occurring before penalties had kicked in.

"After an initial drop, readmissions have not fallen by much," Krumholz says. "All of us would have liked to see more of a reduction in readmissions."

The program incentivizes hospitals to keep patients out of the hospital by exacting penalties of up to 3% of a hospital's Medicare reimbursement.

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