Study suggests CMS readmissions penalties may harm some patients

A recent article by Modern Healthcare suggests penalties for patient readmissions administered by the Centers for Medicare and Medicaid Studies (CMS) may be having the unintended consequences of increasing the mortality rate in certain patient demographics. The article cites numbers from a study by the The Journal of the American Medical Association, a peer-reviewed medical journal that publishes original research, reviews, and editorials covering all aspects of the biomedical sciences.


The readmission penalties were set up as one of several measures to lower readmission rates and screen patients for symptoms of medical conditions that may put them back in the hospital and subtract from resources needed to treat other patients. High-risk patients are set up with “navigators” who call and confirm the individual has a follow-up appointment with their primary-care provider. If no appointment is set up, the navigator will set up an appointment with one of the hospital’s outpatient centers.


Under the program, set up by the Affordable Care Act (ACA), hospitals can be fined as much as 3 percent of their Medicare payments from the federal government if patient readmission rates are high enough. The article by Modern Healthcare points out that although the program has succeeded in cutting wasteful care practices and lowered readmission rates, the mortality rate for heart failure patients has increased over the same time period.


Heart failure is the most common reason for readmission to an emergency room and one of the most complex medical conditions for doctors to treat, sometimes making readmission unavoidable. Experts studying medical care in the country believe it is not inconceivable for changes in hospital policy to place a small sample size of patients at risk for serious medical episodes, including fatalities.


Many of the country’s top healthcare policy experts are calling for a review of the policy and studies into whether or not patient health is put at risk as a result. On the other hand, many other experts have expressed positive views of the program, pointing out the overall decrease in patient readmissions and improved efficiency at hospitals.


Whatever the correlation between the CMS readmission penalties and fatalities due to heart failure, patients need to follow their doctor’s orders, take their medication, and scheduling any follow up appointments needed to monitor their condition. Patient adherence to recommended care can have a tremendous impact on the health and wellness of heart failure patients and need to be taken serious so prevent a catastrophic event.


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