Weak Link Between Hospital Readmission Rates and Mortality After Hospital Discharge

Hospital 30-day readmission rates associated with the Affordable Care Act (ACA) for heart failure (HF), acute myocardial infarction (AMI), and pneumonia are weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge, according to a new study.

Since the ACA passed there have been reductions in 30-day readmission rates for US Medicare beneficiaries due to the Hospital Readmissions Reduction Program, which required CMS to decrease payments to hospitals with higher readmission rates for certain conditions, including HF, AMI, and pneumonia.

The study, published by JAMA, evaluated the potential correlation between the reductions in hospital readmission rates and greater 30-day mortality rates through identifying all hospitalizations of Medicare fee-for-service beneficiaries at least 65 years old from January 1, 2008, through December 31, 2014, with a discharge diagnosis of HF, AMI, or pneumonia. From this data, the researchers calculated the 30-day risk-adjusted readmission rates and 30-day risk-adjusted mortality rates after discharge for each condition and each month of the study period.

In the study period, there were 2.9 million hospitalizations for HF, 1.2 million for AMI, and 2.5 million for pneumonia. In January 2008, the mean hospital 30-day risk-adjusted readmission rates (RARRs) and 30-day risk-adjusted mortality rates (RAMRs) after discharge were 24.6% and 8.4% after HF hospitalization, 19.3% and 7.6% for AMI, and 18.3% and 8.5% for pneumonia. When considering the changes between 2008 to 2014, RARRs declined by —0.053% for HF, –0.044% for AMI, and –0.033% for pneumonia.

The research also found that the correlation coefficients in hospitals’ paired monthly changes in 30-day RARRs and 30-day RAMRs after discharge were weakly positive.

“Among Medicare FFS beneficiaries hospitalized for HF, AMI, or pneumonia, reductions in hospital 30-day readmission rates were weakly but significantly correlated with reductions in hospital 30-day mortality rates after discharge,” the authors wrote. “While concerns about unintended consequences of incentivizing readmission reduction have been frequently raised, study findings strongly suggest that mortality has not increased.”

In conclusion, the researchers emphasize that the study results do not support the rising post-discharge mortality associated with reducing hospital readmissions.