Study suggests improvements in reducing hospital readmissions may be misleading

August 27, 2019
Medicare Web

Once enforcement of Medicare’s Hospital Readmissions Reduction Program (HRRP) began in 2012, initial data showed hospital readmissions within 30 days of discharge declined for Medicare recipients admitted to hospitals for certain medical conditions. But according to a new study published in The BMJ, the decrease in inpatient readmissions was outpaced by an increase in overall hospital revisits, creating questions about the overall success of the HRRP.

The study, which used data from 2012 to 2015, found that the increase in revisits was driven by patients receiving outpatient treatment in emergency departments and observation areas rather than being readmitted for inpatient stays.

“Our finding of increased healthcare use during this period was more pronounced after we included all encounters within 30 days of discharge from the index hospital stay—rather than simply including the first revisit,” the study’s authors wrote. They argued that reductions in readmission rates “could be illusory because total hospital revisits after discharge are, in fact, rising.”

So why is there a discrepancy between readmission versus revisit rates? According to the study’s researchers, hospitals may be trying to avoid readmitting patients to dodge CMS penalties under HRRP, a Medicare value-based initiative that financially penalizes hospitals with excess readmissions, suggesting that HRRP may be creating unintended consequences.

“Given that total hospital revisits are rising, nationwide reductions in readmissions could reflect intensified efforts to manage patients who return to a hospital after discharge to emergency departments and observation units rather than improvements in discharge planning and care transitions during index hospital stays, as intended by the HRRP,” the study’s authors wrote.

The researchers conclude that CMS should measure not just hospital readmissions but all hospital revisits “to strengthen incentives to improve quality of care and provide a more comprehensive assessment of care quality and healthcare use in the post-discharge period.”

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