Gulshan Sharma, M.D.

A federal program meant to reduce 30-day readmissions among patients with chronic obstructive pulmonary disease did just that — but mortality rates have increased since the intervention was implemented.

Researchers from the University of Texas Medical Branch at Galveston analyzed data from more than 4.5 million Medicare beneficiaries with COPD to determine whether the Hospital Readmissions Reduction Program worked as intended.

The program, created by the Affordable Care Act in 2010, penalizes hospitals for higher than expected 30-day readmissions rates for non-COPD conditions. Researchers found that the program may be associated with an increase in the 30-day risk of post-discharge mortality rates for some patient groups.

“The benefits of the HRRP to improve health, prevent unnecessary hospitalizations and control Medicare spending have been widely discussed and debated,” said senior author Gulshan Sharma, M.D., director of UT’s Division of Pulmonary Critical Care and Sleep Medicine. “An important concern is the current penalties for readmission do not take into consideration the impact on mortality. Reducing readmissions may inadvertently affect minority and disadvantaged patients. These patients are not only at higher risk for readmission, they may also be at higher risk of dying.”

Lead author Daniel Puebla Neira, M.D., a UT fellow in pulmonary and critical care, said further research is needed to identify factors contributing to the increased mortality.
The full study was published in the American Journal of Respiratory and Critical Care Medicine.