HF readmission rates rose from 2010 to 2017
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Despite the introduction of financial penalties for U.S. hospitals with high HF readmission rates, HF readmission rates rose from 2010 to 2017, according to a new analysis in Circulation: Heart Failure.
According to the study background, CMS implemented the Hospital Readmission Reduction Program (HRRP) in late 2012 to penalize hospitals with higher-than-expected readmission rates by up to 3% of their yearly Medicare reimbursements. The researchers hypothesized that HF readmissions would have decreased after the HRRP was implemented.
Muhammad Shahzeb Khan, MD, MSc, assistant professor of medicine at the University of Mississippi, and colleagues assessed readmission rates from 2010 to 2017 via the National Readmissions Database, which included patients from databases of Medicare and other payers. The cohort included 6,669,313 index HF admissions analyzed for 30-day readmission and 5,077,949 index HF admissions analyzed for 90-day readmission.
During the study period, 18.2% of patients were readmitted at 30 days, and 31.2% of patients were readmitted at 90 days, the researchers wrote.
Adjusted 30-day HF-related readmissions rose from 8.11% in 2010 to 8.7% in 2017 (P for trend = .04), and adjusted all-cause 30-day readmissions rose from 18.3% in 2010 to 19.9% in 2017 (P for trend < .001), Khan and colleagues wrote. For 90-day readmissions, those related to HF rose from 14.8% to 16%, and those for any cause rose from 30.9% to 34.6%.
The researchers found readmissions were higher after the HRRP was implemented than before (30-day HF readmissions, 8.1% vs. 7.7%; 30-day all-cause readmissions, 18.6% vs. 17.5%; 90-day HF readmissions, 15% vs. 14.2%; 90-day all-cause readmissions, 32% vs. 29.9%; P for trend for all < .001). The trends were consistent across subgroups except for low-volume hospitals, Khan and colleagues wrote.
Readmissions declined from 2010 to 2013, were unchanged in 2014 and rose starting in 2015, Khan and colleagues wrote.
“Although results have been variable, some HF transitional interventions such as outpatient multidisciplinary HF clinics, telemonitoring and home visiting programs have shown decreased readmissions and mortality at 3 or 6 months with little or no effect on 30-day readmissions. Hence, considering readmissions at 90 days may provide hospitals with the necessary time to implement, assess and improve these measures,” the researchers wrote.
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