While the Hospital Readmissions Reduction Program (HRRP) may be responsible for reducing 30-day and one-year readmissions for heart failure patients, new research presented Nov. 12 at AHA 2017 in Anaheim, CA, and simultaneously published in JAMA Cardiology suggests the program may be unintentionally associated with increased mortality.

Study authors analyzed data from 115,245 fee-for-service Medicare beneficiaries who were hospitalized for heart failure between Jan. 1, 2006 and Dec. 31, 2014 at 416 U.S. hospitals. Risk-adjusted 30-day and one-year all cause readmission and mortality rates were examined over three separate time intervals: 1) prior to HRRP implementation (January 2006 to March 2010); during HRRP implementation (April 2010 to September 2012); and once HRRP penalties went into effect (October 2012 to December 2014).

Results showed 30-day risk-adjusted readmission rates declined from 20.0 percent before the HRRP implementation to 18.4 percent in the HRRP penalties phase. However, the 30-day risk-adjusted mortality rate increased from 7.2 percent prior to HRRP implementation to 8.6 percent in the HRRP penalties phase. Study authors noted a similar pattern in one-year risk adjusted readmission and mortality rates in the same period, with a decline in the readmission rate from 57.2 percent to 56.3 percent and an increase in the mortality rate from 31.3 percent to 36.3 percent.

"The results persisted despite extensive risk adjustment with prospectively captured clinical data and consideration of hospice use," the authors said. "These findings raise concerns that the HRRP, while achieving desired reductions in readmissions, may have incentivized hospitals in a way that has compromised the survival of patients with [heart failure]." They suggest, that if confirmed, the study’s finding "may require reconsideration of the HRRP in heart failure."

Keywords: AHA Annual Scientific Sessions, AHA17, Patient Readmission, Fee-for-Service Plans, Risk Adjustment, Hospices, Medicare, Heart Failure

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