Conference Coverage

MedPAC: Medicare hospital readmissions program is working

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Michael E. Nelson, MD, FCCP, comments on program decrease

It is likely premature to make any firm conclusions about how effectively this program decreases unnecessary utilization of hospitals. However, it is heartening to know that it did not increase mortality. The one variable that would best control readmissions is patient education. What constitutes an emergency requiring hospital evaluation and potential admission is often not explained to the patient by you and me.

Dr. Michael E. Nelson, FCCP



– The Medicare Hospital Readmissions Reduction Program is working, according to an original analysis of Medicare claims data presented at a meeting of the Medicare Payment Advisory Commission.

“First, readmissions declined,” MedPAC staff member Jeff Stensland, PhD, said during a congressionally mandated staff report to the commissioners. “Second, while observation stays increased, they did not fully offset the decrease in readmissions. Third, while [emergency department] visits also increased, those increases appear to largely be due to factors other than the readmission program. And fourth, in addition, all the evidence we examined suggests that the readmissions program did not result in increased mortality.”

Admitting & Outpatients sign Copyright Kimberly Pack/Thinkstock

While the program is “not perfect, it has appeared to generate some benefits for patients and taxpayers,” including a reduction in readmissions and patients spending less time in the hospital with “at least equal outcomes,” Dr. Stensland said at the meeting.

Taxpayers benefited from a $2 billion reduction in spending on readmissions, which will “help extend the viability of the Medicare Trust Fund.” He noted that improvements to the program will be discussed at future MedPAC meetings.

Not all MedPAC commissioners agreed with the staff analysis.

Dr. Rita Redberg of the University of California, San Francisco
Dr. Rita Redberg
“It just leaves me with a slightly different conclusion, though, because I think it’s really hard to know what’s going on here,” said Rita Redberg, MD, of the University of California, San Francisco. “It’s all observational data. There are questions about temporal trends, other programs going on. I mean, clearly there were good things that happened with the readmission penalty. Hospitals started outpatient programs, pharmacists, nurse to call the patient, but then clearly there were other things going on. And some things are just not preventable, and it may have created perverse incentives not to readmit patients. We don’t know.”

David Nerenz, PhD, of the Henry Ford Health System, Detroit, also was not convinced the program was having an impact, noting that hospital readmissions began to decline even before the program started.

In looking at a graph presented that showed this trend, “I was impressed by the fact that the trend line started coming down all the way to the left side of the graph, and what my eye was impressed with was more just the continuation rather than a change, so I guess I feel cautious saying the program had certain effects because they certainly don’t jump off the graph visually,” Dr. Nerenz said. “I’m not disputing the numbers, but to say just as a clear unqualified conclusion the program reduced readmissions, I’m not so sure.”

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