Mortality, Medical Coding and the (Purported) Drop in Hospital Readmission Rates

Hospital readmission measures have been touted not only as a quality measure, but also as a means to bend the healthcare cost curve. The Affordable Care Act (ACA) established the Hospital Readmission Reduction Program (HRRP) in 2012. Under this program, hospitals are financially penalized if they have higher than expected risk-standardized 30-day readmission rates for acute myocardial infarction, heart failure, and pneumonia. The HRRP has garnered significant attention from the medical community, both positive and negative.

Now, stepping back and putting on my layperson’s hat here, I don’t think anybody wants to go to the hospital, at least for illness, and nobody wants to go back to the hospital, either (which is sensible: superbugs). So on that level, minimizing re-admissions makes a lot of sense. On the other hand, I don’t want to be prematurely discharged, and if I really need to be, I do want to be admitted. Both are aspects of the same thing: I want the hospital to decrease my risk of mortality. As it happens, we’ve had two major studies in HRRP released recently, both bearing on HRRP. The first, from JAMA, focuses on mortality. The second, from Health Affairs, shows that hospitals gamed the medical coding system to make their HRRP numbers seem better than they really are. The results of the first are… not the greatest, but health care policy really is hard; absent proof of malfeasance or some malevolent form of cognitive capture (***cough*** neoliberalism ***cough***), I’m inclined to give a free pass. The second, however, is horrifying. If hospital re-admission data is gamed, how deep does the gaming go?

– Naked Capitalism

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