ACA Initiative Powers Big Readmissions Drop

Hospital readmissions for patients with serious cardiac conditions and pneumonia declined significantly for Californians under the auspices of a federal mandate, but overall costs for treating those conditions also increased considerably.

            That’s the conclusion of data from the Office of Statewide Health Planning and Development, which studied the statewide rates of readmissions for acute myocardial infarctions/heart attacks, heart failure and pneumonia between 2007 and 2013.

 The intent of the agency was to study the clinical and fiscal impact of the Hospital Readmissions Reduction Program, a mandate of the Affordable Care that financially penalizes hospitals for patient readmissions that occur within 30 days of discharge.

            According to the OSHPD data, the readmission rates for patients who suffered from heart attacks dropped 12% from 2007 to 2013, while heart failure readmissions dropped 6%. Readmissions of pneumonia patients dropped by a smaller margin, 4%.

            During the 2010-2013 period at which time the ACA was signed into law and enacted, readmissions for heart attacks declined 7.8%, 6.9% for heart failures and 2% for pneumonia.

            “The ACA-mandated HRRP appears to have reduced unnecessary readmissions for Medicare and non-Medicare patients alike and positively changed the healthcare delivery system for a large number of Californians,” OSHPD declared. It noted that most improvements were likely connected to improved coordination of care for patients after they’re discharged from the hospital.

            The report did not provide a breakdown in readmission rates for individual hospitals, more than 400 of which report data to OSHPD.

            The reductions occurred across all demographic lines, although whites fared better than other groups overall. Readmission rates for whites who suffered heart attacks dropped by 16.7%, declined 7.4% for heart failure and 5% for pneumonia. Among Asians/Pacific Islanders, the rates of heart failure readmissions declined 10.1%. Among Native Americans, rates of readmissions for pneumonia dropped 10.5%, although they rose for that group significantly for heart attacks (52%) and heart failure (up 4.6%).

            Among those patients over the age of 65, readmissions dropped at rates exceeding the average, declining 13.3% for heart attacks, 8% for heart failures and 7% for pneumonia. Males saw a larger decline in readmissions for heart attacks, while females fared better in heart failure and pneumonia readmissions.

            “For state health policy officials concerned about the impact that the HRRP might have on California hospitals and the different types of patients they serve, it is reassuring that decreased readmission rates were regularly observed for males, females and most races/ethnicities,” the report said.

            Declines were also seen among enrollees in private health plans and Medi-Cal in most categories, although heart attack readmissions among Medi-Cal patients rose by 3.6%.

            But heart attack readmissions among the privately insured dropped 21.6%, and 9.9% for heart failure, outstripping the declines among Medicare patients.

            OSHPD observed that “Medicare-aged patients appear to have benefitted most from reduced readmissions when compared to younger patients, and this is not surprising given that hospital incentives target the Medicare population.” However the agency said it was surprised that patients covered by private payers also saw significant readmission reductions.  “It is generally recognized that private insurance often follows Medicare policy with regard to reimbursement and the private sector appears to have elicited an even larger response for its members than Medicare,” the report said.

Pneumonia-related readmissions did rise by 10.2% among those who are self-insured and 21.5% among those categorized as “other.”

            The average hospital length of stay also dropped by one-half day on average for all groups, indicating that longer hospital stays were not tied to a lower likelihood of readmission.

Yet despite the shorter lengths of stay, the net hospital charges for treating heart attacks, heart failure and pneumonia increased during that same time period by 32%, 40%, and 39%, respectively. Although medical price inflation tends to run higher than general price inflation, the Great Recession that began in late 2007 had a tremendous impact on healthcare and hospital prices during the study period.

“Cost or claims data, and adjustments for inflation, are needed to confirm cost changes and to better understand net care costs factoring in reduced lengths of stay, 30-day readmissions, and changes in care delivery,” the OSPHD study said.

Among those who were readmitted, most were for the reasons that brought them to the hospital in the first place: Heart disease, new heart attacks or heart failure for the heart attack victims, congestive heart failure for the heart failure patients, and pneumonia for the pneumonia patients. Episodes of septicemia also played a role in readmissions for all three categories.