CMS hospital readmission reduction program ineffective for COPD, study suggests

Researchers found CMS' Hospital Readmissions Reduction Program slowed adoption of quality inpatient care for people with chronic obstructive pulmonary disease.

The analysis, published in the American Journal of Respiratory and Critical Care Medicine, compared the quality of inpatient COPD care before (January 2010 to September 2014) and after (October 2014 to December 2018) the inclusion of COPD exacerbations in the program. Researchers analyzed data from nearly 950,000 hospital admissions for COPD exacerbation among 995 hospitals.

HRRP, a Medicare program which penalizes hospitals for avoidable readmissions within 30 days of discharge in patients with certain conditions, slowed the use of recommended care. Before the program came into effect, use of recommended care increased 0.16 percent per month; after, it increased by 0.01 percent. The decrease of nonrecommended care also slowed, going from 0.15 percent per month before HRRP down to 0.13 percent per month.

The analysis also found the adoption of ideal care, defined as providing all elements of recommended care and none of nonrecommended care, cut in half, going from 0.24 percent per month before HRRP down to 0.11 percent after implementation.

"Sound health policy must follow evidence; it seems increasingly difficult to justify the HRRP through the lens of COPD, in which posthospital mortality increases are coupled with a slowing of improvements in the quality of inpatient care," the study authors wrote.

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