Heart Failure Readmission Penalties, Care Quality, Outcomes

Study Questions:

What is the quality of care as well as in-hospital and 1-year clinical outcomes among the Get With The Guidelines-Heart Failure (HF) program (GWTG-HF) hospitals with high versus low Centers for Medicare and Medicaid Services (CMS)-determined risk-adjusted 30-day HF readmission rates?

Methods:

The investigators analyzed data from the GWTG-HF registry linked to Medicare claims from July 2008 to June 2011. Using publicly available data on HF (excess readmission ratio [ERR] in 2013), they stratified the participating centers into groups with low (HF-ERR ≤1) versus high (HF-ERR >1) risk-adjusted readmission rates. The authors compared the care quality, in-hospital, and 1-year clinical outcomes across the two groups in unadjusted and multivariable adjusted analysis.

Results:

The analysis included 171 centers with 43,143 participants; 49% of centers had high risk-adjusted 30-day readmission rates (HF-ERR >1). There were no differences between the low and high risk-adjusted 30-day readmission groups in median adherence rate to all performance measures (95.7% vs. 96.5%; p = 0.37) or median percentage of defect-free care (90.0% vs. 91.1%; p = 0.47). The composite 1-year outcome of death or all-cause readmission rates was also not different between the two groups (median 62.9% vs. 65.3%; p = 0.10). The high HF-ERR group had higher 1-year all-cause readmission rates (median 59.1% vs. 54.7%; p = 0.01). However, the 1-year mortality rates were lower among the high versus low HF-ERR group with a trend toward statistical significance (median 28.2% vs. 31.7%; p = 0.07).

Conclusions:

The authors concluded that quality of care and clinical outcomes were comparable among hospitals with high versus low risk-adjusted 30-day HF readmission rates.

Perspective:

This study reports that adherence to HF process of care measures was comparable at GWTG-HF participating centers with high versus low risk-adjusted 30-day HF readmission rates, and overall short- and long-term clinical outcomes were not different between the two groups. Overall, these findings suggest that the 30-day readmission metric currently used by CMS to determine readmission penalties may not be associated with quality of care or overall clinical outcomes, as indexed by the composite rates of 1-year mortality or all-cause readmission among GWTG-HF participating centers. Additional prospective studies are needed to determine how readmission penalties levied by CMS have affected quality of care and outcomes in hospitals over time. In the future, government agencies should facilitate an environment of integrated health care systems and market-based competition, within which consumers can drive the advancement of their own health.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure

Keywords: AHA Annual Scientific Sessions, Delivery of Health Care, Integrated, Heart Failure, Outcome and Process Assessment (Health Care), Patient Readmission, Primary Prevention, Quality Improvement, Quality of Health Care, AHA16


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