Medicare Analysis: No Link Between Postdischarge Mortality and HRRP Announcement

An increase in in-hospital postdischarge mortality was not seen following the announcement and implementation of the Heart Hospital Reduction Program (HRRP), results from a new study suggest.  

The cohort study looked at adjusted trends in 30-day postdischarge mortality after hospital discharge for three conditions (acute myocardial infarction [AMI], heart failure [HF], and pneumonia). Drawing upon Medicare data captured between 2006 and 2014, the analysis included 1.7 million AMI hospitalizations, 4 million HF hospitalizations, and 3.5 million pneumonia hospitalizations. The main outcome was monthly risk-adjusted rates of in-hospital and 30-day postdischarge mortality.  

No evidence for increase in in-hospital or post-discharge mortality for Medicare beneficiaries hospitalized with AMI, heart failure or pneumonia following the announcement/implementation of HRRP @rohan_khera @hmkyale https://t.co/U9rqc5Vu3N pic.twitter.com/DNa8HtGXfo

— JAMA Network Open (@JAMANetworkOpen) September 28, 2018

The results suggested that in-hospital mortality decreased for all three conditions (from 10.4% to 9.7% for AMI; from 4.3% to 3.5% for HF; and from 5.3% to 4.0% for pneumonia). Post-discharge mortality decreased from to 7.0 % (from 7.4%; P<0.001 for trend). However, it increased for the conditions of HF and pneumonia (both P<0.001 for trend). The researchers reported no changes in slopes for readmission rates for any of that conditions at the time of the HRRP announcement.  

“Among Medicare beneficiaries, there was no evidence for an increase in in-hospital or postdischarge mortality associated with HRRP announcement or implementation—a period with substantial reductions in readmissions,” the researchers concluded. “The improvement in readmission was therefore not associated with any increase in in-hospital or 30-day postdischarge mortality.” 

Folks, please read the article. "overall mortality related to hospitalizations, accounting for deaths both during & after a hospitalization event, risk-adjusted mortality decreased for all 3 conditions” and no evidence of harm from the policy. https://t.co/1z5AyTjqCL @rohan_khera https://t.co/bZW50JmRM0

— Harlan Krumholz (@hmkyale) September 30, 2018

Best evidence to date that the implementation of the HRRP has not been associated with any unintended increases in mortality. https://t.co/iK5gh3Cwd9

— Amber Sabbatini, MD, MPH (@asabbati1) September 30, 2018

On the heels of increased Readmission policy Mortality…a new justification twist:https://t.co/cuVmE57IDO
“The Medicare claims data they used didn't typically include information about cause of death or end-of-life care, the authors noted.”

— JediPD_MD_MBA (@JediPD_MD_MBA) September 29, 2018

http://twitter.com/ilovebenefits/statuses/1046576885474480128

More good debate on the potential good and bad of the Hospital Readmissions Reduction Program. https://t.co/UNLBmO6ttw

— Robert W. Yeh (@rwyeh) September 30, 2018

Source: JAMA Network Open