The Obamacare program intended to reduce the risk of patients being readmitted after hospitalizations for heart attacks, heart failure, and pneumonia has not caused an increase in mortality risk for patients in emergency departments or observational units, according to a new report.
Doctors from Yale and the University of Texas (UT) Southwestern Medical Center conducted the study, which appears Jan. 15 in The BMJ (British Medical Journal).
The program -- formally called the U.S. Hospital Readmissions Reduction Program -- penalizes hospitals with higher than average readmission rates, and has led to national efforts to reduce the number of patients being readmitted to hospitals. Critics have warned that the program might incentivize hospitals to send home some people who need to be admitted a second time, increasing their risk of dying.
The new study evaluated trends in patient mortality from the time of the readmission program's announcement through its implementation. The researchers found no evidence of an increase in death associated with the program. In particular, among those seen in the emergency department or admitted to an observation ward (and not subsequently re-hospitalized), there was no evidence of an increase in the death rate over time, the researchers said.
This study adds to the evidence that the readmission policy is safe and is not increasing the risk of death by turning away people who need to be re-hospitalized."
Harlan Krumholz, M.D., cardiologist and director of the Yale Center for Outcomes Research and Evaluation (CORE), and senior author of the report
The study revealed that there is a national trend toward increased risk of death in the post-discharge period for patients with heart failure, but that the increase began prior to the announcement of the Obamacare readmission policy.
"We do not yet know the mechanism for the increase in mortality," said lead author Rohan Khera, M.D., of UT Southwestern. "However, the trends in rising mortality are concurrent with a decrease in in-hospital mortality and an increase in discharges directly to hospice facilities."
Khera said nearly half of the heart patients who died after leaving the hospital were patients that hospitals had discharged directly to hospice.
"While far from definitive evidence, these observations do suggest that some of the increase in deaths may represent triage of dying patients from the hospital to the post-discharge period," Khera said.
Khera, R., et al. (2020) Post-discharge acute care and outcomes following readmission reduction initiatives: national retrospective cohort study of Medicare beneficiaries in the United States. BMJ. doi.org/10.1136/bmj.l6831.