Leapfrog CEO: CMS' readmission reduction program is imperfect, but effective

Critics of CMS' Hospital Readmission Reduction Program are often quick to point out its flaws. However, the healthcare industry should work together to refine this program, rather than just "throw the baby out with the bath water," Leah Binder, president and CEO of The Leapfrog Group, wrote in an op-ed for Forbes.

Three takeaways:

1. CMS rolled out the Hospital Readmission Reduction Program in 2012 to address high readmission rates, which cost the U.S. more than $41 billion annually. The program bases 3 percent of a hospital's total Medicare reimbursement on readmission rates. Last year, it saved Medicare more than $2 billion, according to the Medicare Payment Advisory Commission.

2. Ms. Binder cited several studies that identify "unintended consequences" of the readmission reduction program. For example, a 2018 study published in JAMA found the program's implementation was linked to a small — but statistically significant — increase in 30-day mortality rates among heart failure and pneumonia patients.

"Commenters suggest these problems call into question the value of the entire program. But let's not throw the baby out with the bathwater," Ms. Binder wrote. "Other studies have found promising results without the disturbing uptick in mortality rates, so the jury is still out."

3. Ms. Binder said the most promising sign of the readmission reduction program's success is the innovation and leadership coming from hospitals nationwide. She pointed to Boston University Medical Center, which lowered readmissions 30 percent by having nurse advocates conduct follow-up appointments at discharged patients' homes.

"There is a need for ongoing vigilance, flexibility and refinements of the readmissions reduction program. But we should never let the inevitable need for refinements send us backward to the nonsensical policies of the old days," Ms. Binder concluded. "This is a policy that works, as long as we make it better together."

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