The Medicare Payment Advisory Commission (MedPAC), an independent agency established to advise Congress on issues affecting Medicare and health care delivery, recently released its June 2018 report, which includes a chapter calling for the expansion of the Hospital Readmissions Reduction Program (HRRP), noting $2 billion per year in savings for Medicare.

Some health care providers and stakeholders have raised questions regarding HRRP's impact on mortality in heart failure patients and the strength of evidence on the relationship between the 30-day heart failure readmissions measure and mortality. Per the report, MedPAC found, "no compelling evidence to suggest that the readmission reduction policy has had a negative effect on mortality," instead stating that, "To the extent that there is a small effect, our data as a whole suggest the HRRP may have done more to improve than harm mortality rates."

On June 25, the ACC submitted a comment letter to Seema Verma, administrator of the Centers for Medicare and Medicaid Services (CMS), addressing the agency's proposed rule for the Financial Year (FY) 2019 Medicare Hospital Inpatient Prospective Payment System (IPPS) for acute care hospitals among other policies, including HRRP.

While the College agrees that reducing hospital readmissions is an effective strategy for lowering healthcare costs and utilization, the letter urges CMS to consider whether the Hospital 30-Day, All-Cause, Risk Standardized Readmission Rate Following Heart Failure Hospitalization measure should remain as part of HRRP, or any quality program. The letter states, "CMS must ensure that the inpatient payment system, combined with the model of the HRRP, does not create harm patients by incentivizing the delay or discouragement of medically necessary readmissions…CMS should take actions to better understand the impact of the HRRP, specifically the heart failure readmission measure, on patient outcomes."

The final FY 2019 Hospital IPPS ruling is forthcoming. The ACC will continue to closely analyze and communicate updates as they become available.

Keywords: ACC Advocacy, Patient Readmission, Medicare Payment Advisory Commission, Centers for Medicare and Medicaid Services, U.S., Inpatients, Medicare, Medicaid, Prospective Payment System, Hospitals, Heart Failure, Health Care Costs, Health Personnel

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