Hospitals Reduce Readmissions

The Obamacare practice of penalizing hospitals for readmissions appears to work, according to research out Monday.

Hospitals that most commonly readmitted newly discharged patients showed the greatest reductions after Medicare imposed stiff financial penalties, researchers reported in the journal Annals of Internal Medicine.

The policy’s effectiveness highlights a dilemma facing the incoming Trump administration, which has vowed to repeal and replace Obamacare, notes senior author Dr. Robert W. Yeh, Director of the Smith Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center in Boston.

“The President-elect’s inclination to hold people accountable for the work they do seems to be in line with this kind of scheme,” Yeh says. “Paying hospitals for how well they do, and not how much they do, is one of few elements [of Obamacare] that can carry bipartisan support.”

Medicare’s Hospital Readmissions Reduction Program was signed into law in 2010 and implemented two years later. It was an effort to reduce the numbers of patients hospitalized again within 30 days of their initial admission. Some of these admissions were necessary, but wide variation in readmission rates – with little difference in how patients fare – suggested that many patients could have been cared for just as effectively at home.

The federal government focused on penalties for common conditions, including heart attack, heart failure, pneumonia, chronic lung disease and bypass surgery. The penalties are significant, trimming the revenues of nearly 2,600 hospitals – half the nation’s total – by $528 million in 2016, topping last year’s total by about 20 percent, according to a Kaiser Health News analysis of Medicare data released in August.

In the new study, Yeh and his colleagues asked whether readmissions in patients suffering from heart attacks, heart failure and pneumonia were higher in “poor-performing” hospitals because they, or the communities they serve, lack resources to care for the disadvantaged.

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