Lower Readmissions Not Linked to Post-Discharge Mortality Risk

Researchers and advocacy groups have raised concerns that hospitals might not readmit patients out of fear of financial penalties associated with HRRP, thus increasing post-discharge mortality.

A review of more than six million hospitalizations shows no linkage between reduced 30-day readmissions and increased post-discharge mortality, according to a new study today in JAMA.

Yale New Haven Health researchers, led by Kumar Dharmarajan, MD, wanted to see if the Affordable Care Act’s Hospital Readmissions Reduction Program had the unintended consequence of increasing mortality rates. Researchers and advocacy groups have raised concerns that hospitals might not readmit patients out of fear of financial penalties associated with HRRP, thus increasing post-discharge mortality.

Those concerns, apparently, are unfounded, the study showed.

“While concerns about unintended consequences of incentivizing readmission reduction have been frequently raised, study findings strongly suggest that mortality has not increased,” the study concluded.

The researchers examined the correlation of trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge among Medicare fee-for-service beneficiaries 65 years or older hospitalized with heart failure, acute myocardial infarction, or pneumonia from 2008 through 2014. Approximately 6.7 million hospitalizations were identified, as were any changes in risk-adjusted readmission and mortality rates. The data showed that reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge.   

The study authors said their findings could be limited because they examined only three conditions, and the findings may not apply to readmission reductions for conditions not targeted by the ACA.

In an editorial accompanying the study, Karen E. Joynt Maddox, MD, an associate professor at Harvard Medical School, called the findings “certainly good news.”

“There is an emerging literature on strategies that hospitals are using to reduce readmissions, the majority of which relate to improving coordination, communication, and cooperation among physicians and other healthcare professions and across care settings Joynt Maddox wrote. “The fact that these strategies do not inadvertently increase mortality rate, and may even have some positive effects, is even more reason to continue this important work helping patients transition safely from hospital to home.”

Joynt Maddox said the study does not address another key concern – that hospitals are prioritizing readmissions reductions over lowering mortality rates. She noted that mortality for heart failure increased during the study period, held steady for pneumonia, and saw slight improvements for AMI.

The study findings are consistent with earlier research that appeared in JAMA.

However, a study last fall in Journal of Hospital Medicine examined nearly 4,500 acute-care hospitals' hospital-wide readmission rates and compared them with those hospitals' mortality rates in six areas tracked by the Centers for Medicare & Medicaid Services: heart attack, pneumonia, heart failure, stroke, chronic obstructive pulmonary disease, and coronary artery bypass. The researchers found that hospitals with the highest rates of readmission were more likely to show better mortality scores in patients treated for heart failure, COPD, and stroke. That led the study authors to question the use of readmissions as a valid quality indicator in CMS’ hospital rankings.