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Program to Cut Hospital Readmissions is Working

<ѻý class="mpt-content-deck">— MedPAC researchers suggest expanding the policy
Last Updated March 5, 2018
MedpageToday

WASHINGTON -- In 2010, as part of the Affordable Care Act, Congress passed a law allowing Medicare to cut reimbursements to hospitals when patients who had been admitted to the hospital with heart attack, heart failure, or pneumonia were then readmitted within 30 days.

So how is the law working out?

Pretty well, according to researchers at the Medicare Payment Advisory Commission (MedPAC). In 2008, before the law was enacted, 16.7% of discharges from acute care hospitals resulted in readmissions, but by 2015, 3 years after the law took effect, that rate had fallen to 15%, reported MedPAC staff member Craig Lisk at the commission's meeting on Thursday. "Readmission rates for conditions covered by the policy fell faster than those not covered by the program," he added.

In addition, "The rate of change in readmission reduction fell somewhat faster after [the law] passed in 2010 for conditions covered under the program," he said.

During the study period, there was an increase in emergency department (ED) use as well as growth in the use of "observation" status, but those trends didn't seem to be affected by the readmissions penalty program, otherwise known as the (HRRP), said Lisk. "Overall observations and ED visits increased for the Medicare population in general, not just those readmitted ... and the growth began before the HRRP program was passed."

There is some question of whether the declines in readmission are real or due to changes in coding, noted MedPAC staff member Jeff Stensland. "Given totality of data we have, it appears it may be some of both... but it does look like at least some of it is real," he said. Although the program appears to be working, there are some changes that could be made to improve it, such as extending the policy to all conditions, he added.

Commission member Paul Ginsburg, PhD, of the Brookings Institution, a left-leaning think tank here, called the researchers' results "impressive," noting that they were especially so since they compared the results to readmissions for other conditions, "where there is likely to be a spillover. Some thing hospitals are doing to reduce readmissions would be beyond the listed conditions."

Commissioner Rita Redberg, MD, of the University of California San Francisco, agreed. "The overwhelming data suggests the readmission policy is a benefit," she said. "I think you have accurately summarized the data here and the conclusion is correct."

One thing that still need to be looked at is whether any adverse events are occurring as a result of the reduced readmissions, said commission member Alice Coombs, MD, of South Shore Hospital in Weymouth, Mass. "That really is an important question."

Another piece of the puzzle is the change in hospital medicine, with hospitalists taking care of hospitalized patients rather than family physicians or internists, she said. "One of the greatest challenges is the communication [with the outpatient physician] that is supposed to occur when a patient is discharged ... and that's a piece of why readmission rates might be higher in some entities versus others."