AHA 2016: CMS’s 30-day heart failure readmission rates do not help predict clinical outcomes

A registry analysis found that the quality of care and one-year clinical outcomes for Medicare beneficiaries were similar at centers with low and high risk-adjusted 30-day heart failure readmission rates.

Lead researcher Ambarish Pandey, MD, of the University of Texas Southwestern Medical Center in Dallas, and colleagues published their results online Nov. 15 in the Journal of the American College of Cardiology: Heart Failure.

The findings were also presented in an oral abstract session at the American Heart Association Scientific Sessions in New Orleans.

On Oct. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Readmissions Reduction Program to track readmission rates for heart failure, acute MI and pneumonia. The researchers noted that hospitals with excess readmission rates would be penalized by up to 1 percent of their Medicare reimbursement.

For this study, the researchers used data from fee-for-service Medicare claims files and the American Heart Association’s Get With the Guidelines-Heart Failure (GWTG-HF) registry, which includes patients admitted to the hospital for heart failure or who developed significant heart failure symptoms during the hospitalization.

The researchers examined 43,143 participants who were seen at 171 hospitals, including 49 percent that had high risk-adjusted 30-day readmission rates. They noted that CMS based readmission penalties in fiscal year 2013 on data from July 2008 to June 2011.

“The 30-day risk-adjusted excess readmission has been portrayed as a highly reliable and actionable metric of hospital quality of care that may be targeted to improve patient care,” the researchers wrote. “In this context, a reliable and clinically meaningful metric of hospital care quality is expected to predict long-term clinical outcomes such that hospitals identified as high performing have better clinical outcomes on long-term follow-up. Findings from our study suggest that the current policy of using risk adjusted 30-day readmission rate to identify low quality of care hospitals may be problematic.”

The hospitals with high risk-adjusted 30-day readmission rates for heart failure had a higher proportion of female and African-American patients and a lower prevalence of prior cardiovascular disease, prior MI and prior cerebrovascular disease.

Hospitals with low and high risk-adjusted 30-day readmission rates for heart failure had similar adherence rates to the performance measures and similar rates of defect-free care.

There were also no significant differences between the groups with regards to in-hospital mortality or the composite of one-year mortality or all-cause readmission. Hospitals with higher risk-adjusted 30-day readmission rates for heart failure had higher one-year all-cause readmission rates, but they had lower one-year mortality rates.

“Taken together, these findings suggest that the 30-day readmission metric currently used by CMS to determine readmission penalties are not associated with quality of care or overall clinical outcomes as indexed by the composite rates of one-year mortality or all-cause readmission among GWTG-HF participating centers,” the researchers wrote.

The researchers cited a few limitations of the study, including that they only examined Medicare fee-for-service beneficiaries enrolled in hospitals that participated in GWTG-HF. Thus, the results might not be generalizable to other populations. They also only examined hospitals from the first year of the Hospital Readmissions Reduction Program. In addition, they collected data from medical charts, determined one-year outcomes from an administrative database, did not account for multiple testing and did not assess health-related quality of life, patient satisfaction and other outcomes.

“Future studies are needed to determine the impact of [Hospital Readmissions Reduction Program] and interventions aimed at reducing hospital readmissions implemented as a consequence of this policy on quality of care and outcomes in later years,” the researchers wrote.