Critics say pressure to lower hospital readmissions may be backfiring

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Skeptics accuse hospitals of taking shortcuts to improve readmissions numbers.
Skeptics accuse hospitals of taking shortcuts to improve readmissions numbers.

Five years after financial penalties went into place for hospitals with high readmission rates, experts are questioning whether falling return rates mean patients actually are faring better.

In an analysis by STAT, some skeptics say fewer readmissions belie a darker truth — that hospitals are taking shortcuts, and in some cases compromising patient care, to avoid financial pain and public embarrassment.

Long-term care providers, as hospitals' frequent care partners, have similarly been pressured to produce lower rehospitalization rates. One prominent researcher said that the only certainty from the readmissions focus thus far is that more scrutiny has been given to the need for better post-acute care.

University of Michigan researchers found a large percentage of the reduction in readmissions following the Hospital Readmission Reduction Program has been attributable to changes in the way hospitals are describing their patients in claims data. By describing them as sicker, hospitals can increase their risk adjustments and reduce financial penalties.

In addition, researchers at UCLA and Harvard recently published a study that correlated the reduction in readmissions with an increase in 30-day and one-year mortality rates. STAT said the study suggested the program was backfiring for patients, keeping them out of the hospital and jeopardizing their health.

“Bad health policies, like bad drugs, have unanticipated side effects,” said Robert Yeh, M.D., a cardiologist at Beth Israel Deaconess Medical Center.

Yeh and co-author Eric Secemsky found differences in hospital quality only marginally accounted for the the readmission risk for patients with peripheral arterial disease, raising the question of whether financially penalizing hospitals makes any sense.

Other doctors have debated via social media the pros and cons of specific readmission reduction goals, with some looking for a causal link between reimbursement and policy and avoidable deaths.

Yeh said the only certainty at this point is that the readmissions program has focused more attention on the need for hospitals and their post-discharge partners to provide better follow-up care.