Association of the Hospital Readmissions Reduction Program With Mortality Among Medicare Beneficiaries Hospitalized for Heart Failure, Acute Myocardial Infarction, and Pneumonia

Abstract

The Hospital Readmissions Reduction Program (HRRP) was established under the Affordable Care Act (ACA) in 2010 and required that the Centers for Medicare & Medicaid Services (CMS) impose financial penalties on hospitals with higher-than-expected 30-day readmission rates for patients with heart failure, acute myocardial infarction, and pneumonia, beginning in 2012.¹ After the announcement of the HRRP, readmission rates among Medicare beneficiaries declined for target conditions nationwide.^2,3 Recently, however, policy makers and physicians have raised concern that the HRRP may have also had unintended consequences that adversely affected patient care, potentially leading to increased mortality.^4,5 For instance, the financial penalties imposed by the HRRP may have inadvertently pushed some physicians to avoid indicated readmissions, potentially diverted hospital resources and efforts away from other quality improvement initiatives, or worsened quality of care at resource-poor hospitals that are often penalized by the program. However, it is also possible that the same mechanisms by which some hospitals have reduced readmissions, such as improved coordination and transitions of care, resulted in reductions in mortality.