Jason H. Wasfy, MD: The Limitation of Cardiovascular Readmission Penalties

On Saturday at the American College of Cardiology (ACC) 2019 Scientific Sessions in New Orleans, LA, a team from Massachusetts General Hospital presented data indicating that hospitals that treat poorer patients and have worse readmission rates may be less able to improve.

Study author Jason H. Wasfy, MD, director of Quality & Analytics at the general hospital, sat down with MD Magazine® to discuss the findings and consider the value of readmission rates when gauging a facility’s success in treating cardiovascular conditions.

His conclusion? Hospitals that serve poor patients and have high readmission rates may need help to improve performance.

MD Mag: What were the findings of your team’s hospital readmission rate program study?

Wasfy: We're presenting a variety of abstracts this conference that have to do with improving the quality of care and value for patients with heart disease. Today, we're presenting an abstract on the Hospital Readmission Reduction Program (HRRP), in which financial penalties were meant to incentivize hospitals to reduce readmission rates after certain disease conditions. There are concerns that this policy will be harder on hospitals that serve poorer patients.

These hospitals may have fewer resources to improve the quality of care. What we've demonstrated is there are not very strong relationships between the poverty of a hospital's patient population and its ability to improve readmission rates—except for 1 specific group.

Hospitals that face high penalties under HRRP, as well as serve low patient populations seem to have been less able to improve their hospital readmission rates.

So, it raises questions, a lot of important policy questions, about whether a specific group of hospitals—namely, those who face high penalties because they have high readmission rates and have populations that are poor—maybe those hospitals need more help in improving the quality of care.

Are there too many factors that influence cardiovascular care which would make hospital readmission rates a poor metric for success?

No, that's a big criticism of it. There was a debate this morning on the utility of the readmission metrics. I tend to be a little bit positive about the metrics. I think that the jury's still out about some of this association with the law and mortality. It seems to be that, when you use different statistical methods to analyze the problem, you get different results.

So, I think it's far from clear what happened, but there's also evidence that the readmission rates came down quite a bit, which probably improved the quality of care for these patients, and certainly reduced costs. There's a lot of debate about how much the reductions were, but I don't think anyone in this field doubts that there was a reduction of readmission rates associated with this penalty, and I think that it's important to really have an active discussion and debate about this. Because understanding how health policies and payment systems can be changed in ways that improve the quality of care and value for patients is a critically important question.

You're never going to be able to fully improve the quality of care as much as we should be able to with current technology, if you simply pay doctors and hospitals fees for doing specific procedures, services, and visits. It's not a value-oriented system. So, we have to understand how to design policies in ways that best do improve quality and value.

The study, "Relative Effects of the Hospital Readmissions Reduction Program For Congestive Heart Failure on Hospitals That Serve Poorer Patients," was presented at ACC 2019.