Hospital Readmissions Penalties Have Intended Effects.
A federal policy that penalizes hospitals for high rates of readmitting patients who have been treated for heart attacks, heart failure, or pneumonia has led to a decrease in 30-day readmissions not just for those conditions, but for others, a new study led by the School of Public Health shows.
“Medicare 30-day readmissions fell for the three conditions targeted by the Hospital Readmissions Reduction Program, consistent with the goals of the program,” said the study, published in the journal Health Affairs and led by Kathleen Carey, a professor of health policy and management at SPH.
In addition, the study found a “substantial fall in readmissions” for other conditions, which the authors called a “spillover effect” from the federal policy.
The study of hospitals in New York State did not find any significant “unintended effects” from the implementation of the financial penalties, which are assessed on hospitals that have high rates of readmitting patients who have been discharged after treatment for heart attacks, heart failure, or pneumonia. But it did find a “significant growth in admissions” of discharged patients to both hospital emergency departments and so-called “observation” beds, which are not considered inpatient readmissions.
Still, the findings “suggest that the program is impacting hospitals in the direction intended by the ACA [Affordable Care Act],” and found no evidence that it is influencing hospital decisions in a way that might raise concerns about patient care, said Carey and co-author Meng-Yun Lin, a research analyst at Boston Medical Center.
The study compared readmissions at 188 acute care New York State hospitals before and after the Medicare readmissions policy took effect. It found that readmissions for the three targeted conditions fell by 1.3 percent, and that readmissions for other diagnoses fell by nearly 1 percent.
The study did not find statistically significant changes in readmissions for privately insured patients, dispelling concerns that hospitals might try to recoup lost Medicare reimbursements by readmitting more private payers, the authors said.
While the numbers of discharged patients admitted within 30 days to emergency departments and observation beds increased, the authors said there was no spike in inpatient readmissions after the 30-day limit had passed, which could have indicated that hospitals were trying to dodge the penalties.
The study compared the use of observation stays and emergency services for patients with the targeted conditions to those with gastrointestinal conditions. It found that emergency department admissions within 30 days of discharge were proportionately lower for the three conditions than for gastrointestinal diagnoses. However, the use of observation stays for heart attack patients was significantly higher than for gastrointestinal patients, the study found.
“Our models did not, in general, support the hypothesized unintended effects, despite significant growth in use of both observation and emergency services,” the study says. “Readmissions outside the 30-day window generally were falling. This is encouraging because it is inconsistent with any delays in [inpatient] care being associated with avoidance of [the federal] penalties.”
The exception was the large increase in the use of observation services for heart attack patients, which was out of line with Medicare patients with other diagnoses or with privately insured patients.
“Whether this was a direct effect of the [penalty program] is a question that remains,” the authors said.
The use of observation stays, they add, is “a very important area for future research.”
The study was funded by a grant from the Robert Wood Johnson Foundation’s Health Care Financing and Organization initiative.
Submitted by: Lisa Chedekel