While CMS' Hospital Readmission Reduction Program successfully reduces readmissions, the program may also produce unintended care consequences that threaten patient safety, according to an op-ed published in the Journal of the American College of Cardiology.
Gregg Fonarow, MD, director of the Ahmanson-UC Los Angeles Cardiomyopathy Center;
Marvin Konstam, MD, chief physician executive of The CardioVascular Center at Boston-based Tufts Medical Center; and Clyde Yancy, MD, chief of cardiology at Evanston, Ill.-based Northwestern University's Feinberg School of Medicine penned the article.
The physicians argue pressure to reduce readmissions, particularly among heart failure patients, may encourage inappropriate care strategies and shift hospitals' focus away from meaningful quality improvement efforts and patient safety considerations.
The physicians cited a study published July 18 in JAMA, which found a weak, but statistically significant, correlation between reductions in 30-day readmissions and reductions in 30-day mortality rates after discharge. However, hospitals with stable or increasing readmission rates demonstrated increases in 30-day post-discharge mortality. The same study showed 30-day risk-adjusted post-discharge mortality in Medicare patients with heart failure increased from 7.9 percent in 2008 to 9.2 percent in 2014. The Hospital Readmission Reduction Program took effect in 2012.
"It is interesting that the declines in 30-day readmission after [Hospital Readmission Reduction Program] implementation are accepted as evidence of the success of the program, but the reversal in more than a decade of declines in 30-day mortality for [heart failure] is dismissed," the authors wrote. "No level of reduction in readmissions or cost savings should be considered adequate justification for this level of potential harm."
The physicians acknowledged there is no proof of a causal relationship between increasing mortality rates and the Hospital Readmission Reduction Program.
"Our concerns, if corroborated, should prompt immediate consideration for reassessment and revision of the HRRP. If harm has been the consequence of the [Hospital Readmission Reduction Program], we are obliged to exercise appropriate due diligence," they concluded.
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