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Bigger Readmissions Penalties Linked to Declining Rates

By Tinker Ready  
   January 03, 2017

The rate of improvement in preventing hospital readmissions is more rapid among lower-performing hospitals than among high-performing facilities, data shows.

How hard has it been for low-performing hospitals to reduce their readmission rates? That's a question researcher at Harvard decided to explore to by looking at how quickly this group responded to Medicare's 2010 penalty programs.

The high rate of penalties these hospitals earn raised concern that they were at a disadvantage in terms of readmission by "being under resourced or serving vulnerable populations," according to study published by the Annals of Internal Medicine.

The findings suggest that the rate of improvement in preventing readmissions is more rapid among lower-performing hospitals.

The researchers examined hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia reported on Medicare's Hospital Compare Web.

Readmission rates have been declining since the enactment of the Medicare Hospital Readmissions Reduction Program. The researchers found that that at high-performing hospitals, the reduction was 67.6 readmissions per 10,000 discharges. At the lowest-performance hospitals, the reduction was 95.1 per 10,000 discharges.

They looked at data from before the passage of the ACA, January 2000 through March 2010, and compared it to readmission figures collected up to December 2013, more than three years following passage.

Hospitals with no penalties were considered high performing, while any hospitals penalized with a 1% reduction in Medicare payments were considered lowest-performing.

The findings contribute to a general understanding of "how policies motivate healthcare providers to improve performance." So far, the study authors note, evidence that financial incentives improve the quality of care is mixed.

After passage of the healthcare reform law in 2010, "provider organizations improved readmission rates over and above the preexisting trend."

Lead author Jason H. Wasfy, MD, the director of quality and outcomes at the Massachusetts General Hospital Heart Center, along with two of his co-authors, also wrote a commentary on their findings for STATnews, a national life science news site associated with The Boston Globe. They concluded:

"Many drugs have what's called a dose-dependent effect. The higher the dose, the more effectively it fights disease. Penalties for readmission may have a similar dose-dependent effect. Hospitals with bigger penalties appear to have reduced readmissions more than those with smaller penalties. Such a relationship increases our confidence that the penalties are actually causing the improvement, instead of being associated with some other factor that is actually driving the change."

Tinker Ready is a contributing writer at HealthLeaders Media.

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