Readmissions reduction program may be associated with increase in patient-level deaths

https://www.eurekalert.org/pub_releases/2018-12/bidm-rrp121918.php

Public Release: 21-Dec-2018
Beth Israel Deaconess Medical Center

A policy designed to reduce hospital readmissions through financial penalties was associated with a significant increase in post-discharge mortality for patients with heart failure and pneumonia, according to a large-scale study

•••••

"Some policy makers have declared the HRRP a success because they believe that reductions in readmissions solely reflect improvements in quality of care," said Wadhera, who is also a Clinical Fellow in Medicine at Harvard Medical School. "But the financial penalties imposed by HRRP may have also inadvertently pushed some physicians to avoid readmitting patients who needed hospital care, or potentially diverted hospital resources and efforts away from other quality improvement initiatives."

•••••

"Whether the HRRP is responsible for this increase in mortality requires further research, but if it is, our data suggest that the policy may have resulted in an additional 10,000 deaths among patients with heart failure and pneumonia during the five-year period after the HRRP announcement," said Shen.

•••••

"This is an example of how we can't always predict the consequences of applying external incentives to medical care," added Yeh. "It's important that we disseminate this data while continuing to evaluate and discuss the future of policies that financially incentivize the prevention of readmissions to a greater extent than other patient-centered outcomes."