Unintended Consequences of the Hospital Readmissions Reduction Program

Readmission rates have declined since announcement of the Hospital Readmissions Reduction Program (HRRP; part of the Affordable Care Act), but questions remain about whether hospital readmission rates reflect hospital quality (NEJM JW Hosp Med Jan 2018 and N Engl J Med 2017; 377:1055) and whether efforts to prevent readmissions compromise patient safety.

In this retrospective analysis of >8 million Medicare hospitalizations (2005–2015) for heart failure, myocardial infarction (MI), or pneumonia, researchers found some significant associations between HRRP and excess mortality within 30 days of discharge. For patients hospitalized with heart failure or pneumonia, 30-day postdischarge mortality rose by 0.22% after HRRP announcement and by as m…