Researchers asking tough questions about Medicare’s readmission reduction program

Joseph Burns

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health insurance. He welcomes questions and suggestions on insurance resources and tip sheets at joseph@healthjournalism.org.

Photo: Naoki Takano via Flickr

Researchers and health policy experts are questioning the value of Medicare’s efforts to reduce 30-day hospital readmissions.

The latest example came this week when Health Affairs published research on what happened after Medicare added hip and knee replacement surgeries to the list of conditions for which it would penalize hospitals for having high rates of readmissions.

The article, “Impact of Medicare Readmissions Penalties on Targeted Surgical Conditions” is in the July issue of the health policy journal. (Note: AHCJ members have access to Health Affairs as a benefit of AHCJ membership.)

The federal Centers for Medicare and Medicaid Services started the Hospital Readmission Reduction Program (HRRP) in 2013 to track readmission rates for three conditions and added hip and knee surgeries in 2013. In an issue brief published in 2017, the Kaiser Family Foundation has an excellent history of the HRRP, “Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program.

In her reporting for Modern Healthcare on the research in Health Affairs, Maria Castellucci wrote, “The expansion of the CMS’ long-standing readmissions penalty program to hip and knee replacement procedures didn’t lead to significant reductions in 30-day return rates to hospitals, a new study finds.” Castellucci has covered the recent questions that researchers and others are asking about the HRRP.

In a new tip sheet, we explore many of the questions researchers and health policy experts are asking about Medicare’s readmissions reduction initiative.

The findings reported in Health Affairs are in line with results other researchers have reported on the program, Castellucci added. These researchers have shown that most of the improvement in readmission rates happened before the program started because hospitals made performance improvement changes to avoid penalties, she explained. “The program dings hospitals for up to 3 percent of their Medicare payments,” she wrote.

For her latest article, Castellucci quoted Karan Chhabra, M.D., the lead author of the article about hip and knee replacement surgeries saying CMS “may have squeezed all of the juice that was possible out of these penalties.” Chhabra and his co-authors make a similar comment in the article abstract, writing, “that readmission reductions are approaching a ‘floor’ below which further reductions may be unlikely.’  A fellow at the Institute for Healthcare Policy and Innovation at the University of Michigan, Chhabra explains some of the issues in this Twitter thread.

Earlier this year, Castellucci wrote about how coding changes are driving reductions in readmission rates. Last fall, she wrote about how the HRRP could have an adverse effect on patient in an article, “Unintended consequences: CMS’ readmissions program might be harming patients.”

In response to her questions, CMS said in a statement, “Significant reductions in readmissions have been made over time, which CMS believes is due in part to the program linking Medicare reimbursement for hospitals to their performance on readmission rates.” CMS also said it reviews the “relevant literature to inform future actions” for the program.

The tip sheet digs into these and questions surrounding the HRRP.

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