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Study Questions Usefulness of Financial Penalties to Improve Quality of Care

CardioSmart News

Financial incentives to reduce hospital readmissions for heart failure patients may not be as effective as policy makers had hoped, based on a recent analysis of Medicare claims and a national heart failure registry.

Published in JACC: Heart Failure, this study analyzed hospital visits among heart failure patients. Heart failure, which occurs when the heart can’t pump enough blood to the rest of the body, is a chronic condition associated with frequent hospital visits and high costs. With an estimated 5.7 million Americans living with this condition, heart failure is the most common cause of hospitalization in the elderly and costs more than $30 billion each year in the United States.

To improve care and reduce costs, the Centers for Medicare and Medicaid Services implemented the Federal Hospital Readmissions Reduction Program (HRRP) in 2012. Under this program, hospitals with higher than normal readmission rates face financial penalties, equal to 1% of their reimbursement from Medicare. The hope was that with these incentives, hospitals would go the extra mile to provide high-quality care for this particularly vulnerable population.

However, this innovative program may not be as effective as anticipated. After analyzing 2008–2013 data from the Get With The Guidelines—Heart Failure registry and Medicare claims, researchers found that incentives have had little impact on quality of care and outcomes. Among 171 centers that treated more than 43,000 heart failure patients, half had higher-than-normal readmission rates, as defined by the new program. However, mortality rates were actually lower among patients treated at sites with higher readmission rates. Researchers found that all sites provided the same quality of care based on treatment guidelines.

The take-home message, according to authors, is that the Hospital Readmissions Reduction Program may not be enough to improve quality of care for heart failure patients. While financial penalties are a useful strategy in health care reform, the current policy design may not be enough to change outcomes. With future research, experts hope to continue to assess current policies and identify future strategies to improve health care in the United States.

Read the full article in JACC: Heart Failure. Learn about CardioSmart's editorial process. Information provided for educational purposes only. Please talk to your health care professional about your specific needs.