1/Lots of sturm and drang about national readmission program. @JAMA_current and @nytimes give platform to vocal critics of the policy. Worth exploring this a bit.
@JAMA_current @nytimes 2/~16% who are hospitalized get so sick during recovery that they need to be readmitted w/i 30 days. Many, including @leorahorwitzmd @ehbvassar us & others have identified quality gaps that contribute to readmission risk. E.g.: ahajournals.org/doi/full/10.11… jamanetwork.com/journals/jamai…
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar 3/ The risk of readmission is a property of the hospital, independent of the patient. Same patient admitted with same diagnosis to a hospital with poorer readmission performance will have a higher risk of readmission. Published in @nejm… nejm.org/doi/full/10.10…
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM 4/The Hospital Readmissions Reduction Program (HRRP) provided an incentive for hospitals to improve quality related to readmission; before that, hospitals just added more revenue with each readmission. That’s fee-for-service.
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM 5/HRRP was associated with a decline in readmissions without evidence that changes in observation-unit stays accounted for the decrease. Published in @nejm… nejm.org/doi/full/10.10…
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM 6/Hospitals that have improved their readmission rates tended to improve their mortality rates. Published in @JAMA_current… jamanetwork.com/journals/jama/…
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM 7/@medicarepayment (MedPAC) conducted a Congressionally-mandated investigation of HRRP and concluded it was largely successful and safe. And save $2b per year. medpac.gov/docs/default-s…
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM @medicarepayment 8/Importantly, /@medicarepayment concluded “we find no compelling evidence to suggest that the readmission reduction policy has had a negative effect on mortality.” The report is well worth reading. MedPAC is independent and rigorous. medpac.gov/docs/default-s…
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM @medicarepayment 9/In September we wrote: Association of Hospital Readmissions Reduction Program W/Mortality During & After Hospitalization for Acute Myocardial Infarction, Heart Failure, and Pneumonia @JAMANetworkOpen @rohan_khera @KDharmarajanMD
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@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM @medicarepayment @JAMANetworkOpen @rohan_khera @KDharmarajanMD 10/We found “no evidence for an increase in in-hospital or postdischarge mortality associated with HRRP announcement or implementation.” I believe our methodology was superior to articles that found otherwise. People can decide for themselves.
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM @medicarepayment @JAMANetworkOpen @rohan_khera @KDharmarajanMD 11/The most recent paper raised questions about whether mortality rose .21% for HF in association w/HRRP. But their findings were not consistent across conditions. They admit they were not designed to prove if HRRP caused higher mortality.
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM @medicarepayment @JAMANetworkOpen @rohan_khera @KDharmarajanMD 12/That paper found HRRP not associated with any change in mortality w/i 45 days of hospital admission. That seems reassuring, esp since it is from critics. But it was the basis for a scathing editorial and op-ed.
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM @medicarepayment @JAMANetworkOpen @rohan_khera @KDharmarajanMD 13/In disclosure, our group has focused on improving readmission risk. We developed the @CMSGov national measures. Have done studies identifying quality targets. And demonstrated how to improve. We have also studied the safety of the policy. We care. I am sure the others do too.
@JAMA_current @nytimes @leorahorwitzmd @ehbvassar @NEJM @medicarepayment @JAMANetworkOpen @rohan_khera @KDharmarajanMD @CMSGov 14/Where does it leave us? Not sure. Different groups/scientists have very different views of evidence. Making positive change, as HRRP did, is difficult to do. Did doctors put people in harms way for the economic benefit of hospitals? I say no, others not so sure. More to come.
@threadreaderapp rollup
