Quality of care and clinical outcomes were comparable among hospitals with high vs. low risk-adjusted 30-day heart failure (HF) readmission rates, according to the results of research presented Nov. 15 during AHA 2016 and simultaneously published in JACC: Heart Failure. The findings raise questions about the impacts of the Centers for Medicare and Medicaid Services (CMS) 30-day readmission metric on patient outcomes and quality of care.

Researchers analyzed data from 171 centers enrolled in the GWTG-HF Registry linked to Medicare claims from July 2008 to June 2011. Publically available data on HF-excess readmission ratio in 2013 were stratified into two groups based on low vs. high risk-adjusted readmission rates. Care quality, in-hospital, and one-year clinical outcomes were compared across the two groups in unadjusted and multivariable adjusted analysis.

Overall results found that 84 centers (49.1 percent) had higher-than-expected risk-adjusted 30-day HF readmission rates and received a readmission penalty in 2013. Researchers noted no differences between the two groups in median adherence rates to all performance measures or median percentage of defect-free care. Additionally, the composite one-year outcome of death or all-cause readmission rates did not differ between the two groups. Of note, however, hospitals with low risk-adjusted 30-day HF readmission rates had significantly lower one-year all-cause readmission rates (median 54.7 percent vs. 59.1 percent; p = 0.01), but a trend toward paradoxically higher 1-year morality rates (median 31.7 percent vs. 28.2 percent; p = 0.07).

"These findings suggest that the 30-day readmission metric currently used by CMS to determine readmission penalties are not associated with quality of care or overall clinical outcomes as indexed by the composite rates of one-year mortality or all-cause readmission among GWTG-HF participating centers,” the researchers conclude. Moving forward, they recommend future prospective studies to determine the impact of readmission penalties on quality of care and patient outcomes over time.

In an accompanying editorial comment, Marvin A. Konstam, MD, FACC, writes: "The 30-day readmission metric, with its many flaws, and clear direction to reduce utilization and cost, but without focus on patient wellbeing, should serve as an alarm that we are heading in the wrong direction of allowing government policy-makers, rather than patients to drive the design of clinical care metrics. Alternatively, the government can and should play an important role in facilitating an environment of integrated health care systems and market-based competition, within which consumers can drive the advancement of their own health."

Keywords: AHA16, American Heart Association, 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

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