Hospital readmission penalties fail to improve care quality for ... - Healio
February 07, 2023
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Disclosures: Press reports receiving grant funding from AHRQ, American Lung Association and NIH; receiving consultant fees from Humana and Vizient; and participating on NIH R34, a data safety monitoring board. Please see the study for all other authors' relevant financial disclosures. Buhr reports receiving support from the COPD Foundation, NIH, Novartis and Sunovion; grants from NIH/NCATS and NIH/NHLBI; consultant fees from the American College of Physicians/DynaMed and 2ndMD; and payments from Theravance Biopharma/Viatris. Krishnan reports receiving support from the COPD Foundation and NHLBI; receiving grants from American Lung Association, Patient Centered Outcomes Research Institute, Regeneron and Sergey Brin Family Foundation; receiving consultant fees from GSK; and having roles on the COPD Foundation Medical and Scientific Advisory Committee and Respiratory Health Association Board of Directors.
Quality of care for patients with acute exacerbations of COPD did not improve after the Hospital Readmissions Reduction Program was put in place compared with the period prior to the program's implementation, according to study results.
Valerie G. Press
"Our hypothesis was that the Medicare Hospital Readmission Reduction Penalty would facilitate improved quality of care for patients with COPD through efforts to reduce readmissions," Valerie G. Press, MD, MPH, FACP, FAAP, SFHM, ATSF, associate professor of medicine and pediatrics and executive medical director of specialty value-based care at The University of Chicago, told Healio. "While it was not unexpected that quality of care was improving prior to the implementation of the Medicare penalty, we did not expect that the rate of improvement would slow post-penalty implementation."
In a retrospective cohort study published in American Journal of Respiratory and Critical Care Medicine, Press and colleagues used data from the Premier Healthcare database to analyze the quality of care patients hospitalized with acute exacerbations of COPD aged older than 40 years received across 995 U.S. hospitals before and after COPD exacerbations became a condition of the Hospital Readmissions Reduction Program (HRRP) in October 2014.
Researchers tracked changes in quality of care by evaluating adherence to recommended inpatient care treatments (including chest radiography, systemic corticosteroids, bronchodilators and antibiotics) and nonrecommended care (sputum examinations, acute spirometry, mucolytic agents or methylxanthine bronchodilators). They defined ideal care as receiving only the recommended care.
The analysis included data of 662,842 patients (mean age, 67 years; 60% women; 75% white) before HRRP was implemented from January 2010 to September 2014 and 285,508 patients (mean age, 67 years; 61% women; 77% white) after HRRP was implemented from October 2014 to December 2018.
Based on the findings, HRRP did not improve quality of care. Researchers found that use of recommended care only increased by 0.01% per month with HRRP compared with an increase of 0.16% per month before HRRP (P < .001).
Per month, patients receiving nonrecommended care decreased by 0.13% after HRRP, which was less than the decrease of 0.15% per month before HRRP implementation.
Compared with the rate before HRRP, HRRP implementation was related to a lower increase in ideal care per month (0.11% vs. 0.24%; P < .001).
Press told Healio two important findings came out of these results.
"First, clinicians need to remain vigilant about providing ideal care to our patients hospitalized with COPD exacerbations including providing guideline-recommended care and not providing care that is not recommended," she said. "Second, policy only may not be sufficient to galvanize improved adherence to clinical guidelines such that system-based approaches are needed to facilitate providing high quality and value of care.
"Ideally, future studies on the quality of care provided to patients hospitalized with COPD can evaluate both the clinical inpatient treatments as well as the care transition interventions provided across in-patient and outpatient settings to better ensure patients with COPD are supported to have high quality of life without repeat COPD exacerbations and/or the need to be re-hospitalized," Press added.
This study by Press and colleagues adds another study to recent literature that has shown an increase in COPD mortality rates among Medicare beneficiaries after the implementation of HRRP, according to an accompanying editorial by Russell G. Buhr, MD, PhD, pulmonary and critical care physician at UCLA Health, and Jerry A. Krishnan, MD, PhD, associate vice chancellor for population health sciences and professor of medicine and public health at University of Illinois Chicago.
"Sound health policy must follow evidence; it seems increasingly difficult to justify the HRRP through the lens of COPD, in which posthospital mortality increases are coupled with a slowing of improvements in the quality of inpatient care," Buhr and Krishnan wrote.
For more information:
Valerie G. Press, MD, MPH, can be reached at vpress@bsd.uchicago.edu.
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