In the ongoing debate of whether to use the carrot or the stick, the stick appears to have achieved effective results in the form of reduced hospital readmissions.
Modern Health Care reported that Medicare's initiation in 2012 of fines for short-term acute hospitals with "excessive readmissions for certain conditions" has borne fruit in the form of reduced readmissions.
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According to the report, a study in the Annals of Internal Medicine found that hospital readmissions began to fall with the passage of the Affordable Care Act, which at its inception in 2010 established the Hospital Readmissions Reduction Program. HRRP allowed the Centers for Medicare and Medicaid Services (CMS) to withhold inpatient prospective payments for what it believed were excessive readmissions.
The debate is far from over, as might be expected, especially since there are still arguments about whether hospitals with sicker patients are unfairly penalized and whether reduced readmissions actually translate to better care, among other things. However, one thing is clear: readmissions are down. And that phenomenon began with the passage of the ACA. Not only that, but hospitals that readmitted the most patients prior to 2010 improved the most in the years following.
The records of more than 15 million fee-for-service Medicare patients discharged from 2,868 acute-care hospitals for heart attacks, congestive heart failure or pneumonia from 2000 to 2013 were studied by the researchers, who then calculated risk-standardized readmission rates and categorized hospitals into four categories of performance: highest, average, low and lowest.
Overall readmissions fell after 2010, which the researchers called the "post-law period," but lower-performing groups showed more improvements than higher-performing groups. Risk-standardized readmissions fell by 69 and 74.5 per 10,000 discharges annually among the highest- and average-performing groups, the report said, but among the low- and lowest-performing groups fell by 83.2 and 92.4 per 10,000 discharges, respectively.
"There's been a gradual, a progressive, graded attention devoted to the issue of readmissions," Dr. Robert W. Yeh, an author of the study and an interventional cardiologist at the Beth Israel Deaconess Medical Center in Boston, says in the report. He added that, while it would not be possible to "disentangle what the various forces are" — such as financial penalties, public reporting or extra attention to readmissions — and how those factors contributed to reduced readmissions, the study showed that "financially incentivizing reduced readmissions leads to reduced readmissions."
In their conclusion, the authors of the study write, "Our main findings suggest that passage of the law was followed by widespread reductions in readmission rates, even with control for pre-law trends, and that this effect was most concentrated among the lowest-performing hospitals."
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