Although efforts to reduce hospital readmissions are working in some ways, they’re not always saving money, according to a new study from Los Angeles-based Cedars-Sinai.
Many medical centers are tackling healthcare’s readmission problem by trying to pinpoint the root causes of unnecessary repeat hospitalizations. As such, a Cedars-Sinai-led team of investigators systematically evaluated the effectiveness and financial benefit of quality improvement programs at medical centers in the U.S. and elsewhere. The study was published this week in the Journal of the American Medical Association Internal Medicine.
The team, led by Teryl Nuckols, M.D., conducted a systematic review of data from 50 quality improvement studies involving more than 16,700 patients. One of the core findings of the research was that quality improvement interventions reduced readmissions by an average of 12.1 percent for heart failure patients and 6.3 percent for older adults with diverse health issues.
However, the research also revealed that savings to health systems varied. The investigators examined how much money these interventions saved or cost health systems by measuring expenses for hospitals, physicians, other providers and payers. They found average net savings for health systems of $972 per person among heart failure patients and average net losses of $169 per person among other patients. However, costs varied so widely across studies that the authors could not conclude definitively whether these interventions saved or lost money.
The federal government’s penalties on hospitals for failing to lower their rehospitalization rates hit a new high in 2016 as Medicare withheld approximately $528 million—about $108 million more than the year prior—according to a Kaiser Health News report from last August. What’s more, the government will penalize more than half of the nation’s hospitals — a total of 2,597 — having more patients than expected return within a month.
The Hospital Readmissions Reduction Program, created by the Affordable Care Act (ACA), was designed to make hospitals pay closer attention to what happens to their patients after they get discharged. The fines for failure to meet the criteria of the Centers for Medicare & Medicaid Services (CMS) focus on six conditions: heart attack, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), elective hip and knee replacements, and for the first time last year—coronary artery bypass graft surgery.
Among older adults in the study, interventions that engaged patients and caregivers yielded the most net savings per patient, the researchers found. For example, several interventions involved nurses or pharmacists training patients and family members about how to manage medications after discharge, which types of activities are appropriate and which symptoms might represent something serious.
Nuckols, director of the Division of General Internal Medicine in the Cedars-Sinai Department of Medicine, said she was surprised that the interventions didn’t save more money across the board. Nuckols said the results counter a widely held belief that reducing readmissions should save money by preventing additional costs for return hospital stays.
“Hospitalization is very expensive, so avoiding even a few readmissions should have saved a lot of money,” she said. “Our findings suggest that there is no guarantee of net cost savings once the implementation costs associated with efforts to prevent readmissions are considered.”
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