Hospitals Incorrectly Penalized for Readmissions

 Friday, October 16, 2020

A recent study published in JAMA Cardiology found that the Centers for Medicare & Medicaid Services (CMS) Hospital Readmission Reduction Program incorrectly penalizes hospitals due to margins of error associated with the 30-day risk-adjusted readmission measure.  

The study evaluated three of the six conditions that are part of the program: acute myocardial infarction, pneumonia and heart failure. It found that between 2014 and 2017, 20.9 percent of hospitals should have been penalized for readmission rates for acute myocardial infarction but weren’t, while 13.5 percent should have received a penalty for readmission rate for heart failure and 13.2 percent for readmission rate for pneumonia. During the same time, same time, 10.1 percent of hospitals received a penalty for performance on readmissions for acute myocardial infarction but shouldn’t have, while 10.9 percent were incorrectly penalized for heart failure and 12.3 percent for pneumonia.  

According to researchers, the margin of error associated with the 30-day RSRRs resulted in the misclassification of condition-specific penalty status for up to 31 percent of hospitals, and it was suggested that the hospital-level 30-day RSRR measure may not reliably distinguish hospital performance in the HRRP.  Researchers also recommended that CMS lengthen the data collection period from three years to 12 years for acute myocardial infarction and six years for pneumonia and heart failure.