A Team of MD Leaders Calls for the Phase-Out of the Readmissions Reduction

Is it time for healthcare policy leaders—and the leaders of patient care organizations—to move beyond inpatient readmissions reduction as a core measure of quality performance? That’s precisely what three physicians who are healthcare policy leaders, say in an op-ed online in the JAMA Network.

Indeed, the very title of the piece by Peter Cram, M.D., Robert M. Wachter, M.D., and Bruce E. Landon, M.D., is conveyed in the headline of the article, “Readmission Reduction as a Hospital Quality Measure: Time to Move on to More Pressing Concerns?”—which was published online in the “Viewpoint” section of the JAMA Network on Oct. 6.

What’s more, these are prominent physicians, particularly Dr. Wachter, who is chair of the Department of Medicine in the School of Medicine at the University of California, San Francisco, and who is well-known for having authored the 2017 book The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age. Meanwhile, Dr. Cram is chair of Internal Medicine at the University of Texas Medical Branch at Galveston (UTMB); and Dr. Landon is a professor of healthcare policy in the Department of Health Care Policy at Harvard Medical School; and Dr. Landon is a professor of medicine and a practicing internist at Beth Israel Deaconess Medical Center (Boston).

And these three healthcare policy leaders are clear on their contention in their JAMA Network op-ed, as they write that, “In this Viewpoint, we argue that the persistent focus on readmissions during the past decade, although undoubtedly leading to some improvements in care, has had minimal demonstrable benefit. Moreover, the HRRP [Hospital Readmissions Reduction Program] has distracted clinicians and health system leaders from other crucial quality concerns. As with many other quality measures, the HRRP has led to gamesmanship (described below) whereby hospitals have taken predictable actions in their coding practices and admission processes and protocols in an effort to minimize the probability of receiving penalties. It is time to refocus hospital quality improvement efforts where they can be most effective and beneficial, which means deemphasizing the HRRP.”

The authors of the article note that, “In a 2009 study, Jencks et al reported that among 11.8 million Medicare beneficiaries who were hospitalized in 2003 to 2004, 19.6 percent were readmitted in the first month after the hospitalization, and these readmissions accounted for an estimated cost of $41 billion annually. Researchers and policy makers inferred that if a significant proportion of readmissions was caused by failures of the health care system—whether due to inadequate treatment during the initial hospitalization or failure of care coordination after hospital discharge—then the adoption of policies designed to reduce inappropriate readmissions would be warranted, particularly because hospitals receive additional payments when patients are readmitted.” Not only did the Jencks study lead to an intense focus on readmissions as a core indicator of the quality of inpatient care; the HRRP ended up becoming embedded in the Affordable…