A review of nearly 2.5 million joint replacement cases found an expansion of  the Centers for Medicare & Medicaid Services’ readmissions penalty program didn’t bring about significant changes in 30-day rehospitalization rates.

Researchers behind the new study said it might be time for CMS to end the Hospital Readmissions Reduction Program (HRRP), which incorporated hip and knee replacements in 2013.

HRRP started in 2010, but federal officials didn’t tell hospitals readmission related to specific joint replacement procedures would be cause for penalty until 2013. Reductions in 30-day readmission rates for those surgeries nearly doubled from 2010 to 2013 but then returned to pre-2010 reduction rates after the program was actively expanded to those procedures.

“Though hospitals appear to be running out of room for improvement in readmissions, CMS continues to broaden the program,” wrote lead author Karan Chhabra, M.D., a fellow at the Institute for Healthcare Policy and Innovation at the University of Michigan. “Policy makers should consider ways to preserve the care improvements that have resulted from the program while drawing back the size and scope of its penalties.”

Chhabra argued a certain number of readmission “may be necessary and a sign of appropriate care for surgical patients.” But his data, published in HealthAffairs this week, suggests there is a floor for reductions.

The research team also studied whether the focus on preventing readmissions drove up costs associated with lengths of stay or the use of postacute care.

Instead, they found total episode payments for joint replacement were rising before the HRRP and began declining with the program’s announcement. Notably, lengths-of-stay declined, discharges to home increased, and the use of skilled nursing and rehabilitation facilities decreased over the study period.

“It may be time to focus political and regulatory attention on the next generation of strategies to improve quality — and limit the harms of programs that have achieved their goals,” the team reported.

Among their suggestions: using bundled payment programs to incentivize patient care coordination and improve expenditures.