Hospitals Showed Gains Before Penalty Program Started

Hospitals were reducing some patient readmission rates even before a federal penalty program began, a new study has found.

• The proportion of patients returning to the hospital on account of infections from heart or bladder catheters was coming down some two years before a government penalty scheme started.
• A Harvard study published in the New England Journal of Medicine has reported the findings.  Dr. Grace Lee of Harvard Medical School led the study.
• Researchers looked at the records of about 400 hospitals in 41 states.   They focused on blood stream infections in the heart and catheter-related infections in the urinary tract.
• CMS is putting more penalties into effect this year.  They’ll cut hospital payments for having too many patients readmitted for a longer list of conditions.
• Healthcare leaders have long said that providers will innovate to address problems, with or without penalties imposed by the government.

Healthcare providers have worked to curb hospital readmissions because they were a problem needing attention, not because of a government carrot or stick.

• In October 2008, the Centers for Medicare & Medicaid Services began cutting reimbursement payments to hospitals when certain hospital-acquired conditions occur.
• Hospital data from around the country show that hospitals were making progress cutting down on patient readmissions by 2006.
• Researchers found the rates of infections from heart and bladder catheters decreased both before and following the penalty program.
• For infections not subject to payment penalties, the study tracked them as falling, too.  For example, pneumonia related to ventilators didn’t face cuts in Medicare payment.  But this hospital-acquired infection occurred less often, showing a trend similar to the penalized infections.
• Some infection rates fell at slower paces after the penalty went into effect, the study showed.
• The bottom line is clear.  As chief researcher Dr. Lee told the Boston Globe, “[Declines in hospital-acquired infections] had really nothing to do with the CMS policy.”

Healthcare leaders support improving quality and patient safety in hospitals and other parts of the healthcare system.  We support getting the greatest value from the healthcare dollar.  Generally, policies using carrots work better than sticks for getting different outcomes.  Providers strive to make improvements in quality and safety of medical care anyway.  This study shows how hospitals around the nation were finding ways to reduce readmissions before the government adopted a stick approach.