Medical billing data entry provided by medical billing companies is significant not only from the point of view of physician reimbursement, but also for studying health trends, treatment protocols and their efficacy. A recent study led by UCLA and Harvard University researchers has found that the analysis of clinically collected data confirms the results of an earlier analysis of billing data – the Hospital Readmission Reduction Program (HRRP), a major federal policy implemented under the Affordable Care Act is associated with an increase in mortality of patients. Now, for some background. Several advancements in the field of medicine such as insurance coverage, medical eligibility verification and more have transformed the landscape of healthcare domain in the United States. Medicare provides coverage to about 56 million people who are 65 years and older, as well as disabled people. The Affordable Care Act (ACA) has introduced numerous financial incentives and penalties to optimize the overall healthcare system performance. The Hospital Readmission Reduction Program is one such major initiative launched by the Centers for Medicare and Medicaid Services (CMS) in 2013 to encourage hospitals to reduce readmission rates by providing them financial incentives. Hospital readmission is defined as a patient being readmitted within 30 days of discharge from the hospital. As part of this program, medical facilities with excess 30-day readmissions for patients with certain health conditions such as pneumonia, myocardial infarction and heart failure will be penalized.
However, a new study has found that the hospital readmission reduction program (HRRP) that is focused on keeping some patients out of the hospital relates to higher death rates. The study conducted by researchers at UCLA and Harvard University analyzed around 115,245 fee-for-service Medicare beneficiaries at 416 hospitals. It was found that the implementation of HRRP program was linked to a decrease in readmissions at 30 days after discharge and at one year after discharge among people hospitalized for heart failure. The results of the study were published in the journal JAMA Cardiology.
Through HRRP program, Medicare penalizes about two-thirds of US hospitals based on their 30-day readmission rates. However, the data suggests that it incentivized strategies that unintentionally harmed patients with heart failure.
Using data from the American Heart Association’s (Get with the Guidelines-Heart Failure program), a voluntarily quality improvement initiative at hospitals, researchers made a comparison between heart failure patients’ readmission rates, mortality rates and characteristics along with hospital characteristics from the period January 2006 to December 2014.
The research findings indicate a major reversal in a trend of declining death rate among patients with heart failure, which researchers concluded was directly linked to the implementation of the Hospital Readmission Reduction Program (HRRP). Reductions in the readmission rates signify an increase in the ultimate outcome – patient deaths. Researchers point out that if a patient dies, then that patient cannot be readmitted.
Even though the hospital readmission program plays a major role in reducing the number of re-hospitalizations and decreasing the total healthcare costs, the policy is focused too narrowly on not readmitting patients to hospitals. To avoid these penalties, hospitals now offer incentives to keep patients out of hospitals longer (possibly even if previously some of these patients would have been readmitted earlier for clinical reasons). Therefore, this policy of lowering readmissions is aimed at reducing utilization for hospitals rather than directly focusing on improving quality of patient care and outcomes.
Researchers are now analyzing which type of hospitals and patients are most affected by this new trend. The new study data signifies the need for reconsideration of the policy’s use for patients with heart failure.