Researchers from The University of Texas Medical Branch at Galveston have found that while the 30-day readmission
rate for patients with chronic obstructive pulmonary disease has decreased, the mortality rate has increased.
The UTMB researchers analyzed data from a nationwide cohort of more than 4.5 million Medicare beneficiaries with COPD
to learn more about the impact of a federal program designed to reduce the number of people needing hospitalization
within the first 30 days after being released from the hospital for a COPD-related illness.
The findings, said first author Daniel Puebla Neira, UTMB Pulmonary & Critical Care Fellow, are concerning in
that some hospitals, in seeking to avoid financial penalties by reducing readmissions, may inadvertently affect
minority and disadvantaged patients – people who may have a higher risk of dying.
The findings are currently available in the American Journal of Respiratory and Critical
COPD is the third leading cause of death in the United States, affecting 12.7 million Americans and about 800,000
patients are hospitalized with COPD each year. Of these, 1 in 5 patients are readmitted after being discharged from
the hospital, which is linked with poor outcomes and costs about $13 billion annually. In order to improve the
patients’ long-term health and control rising healthcare costs, the Patient Protection and Affordable Care Act
created the Hospital Readmissions Reduction Program, or HRRP, in March 2010. The program began penalizing hospitals
for higher than expected 30-day readmissions rates for non-COPD conditions.
Since the creation of the program, hospitals have reduced their readmission rates. However, it was also suspected
that the program may be associated with an increase in the 30-day risk of post-discharge mortality rates for some
groups of patients currently participating in the program.
“The benefits of the HRRP to improve health, prevent unnecessary hospitalizations, and control Medicare
spending have been widely discussed and debated,” said senior author Dr. Gulshan Sharma, director of the
Division of Pulmonary Critical Care & Sleep Medicine. “An important concern is the current penalties for
readmission do not to take into consideration the impact on mortality. Reducing readmissions may inadvertently
affect minority and disadvantaged patients. These patients are not only at higher risk for readmission, they may
also be at higher risk of dying.”
The research team analyzed data from 4,587,542 Medicare fee-for-service beneficiaries with COPD who were 65 years and
older. The study period from 2006 to 2017 covers the creation of HRRP and the introduction of COPD to the program.
The data revealed that while the program does decrease the 30-day hospital readmission rate, it also significantly
increases in the risk-standardized 30-day post-discharge mortality rates across the nation.
“Further research is needed to confirm our findings and identify factors contributing to the increased
mortality seen in patients with COPD in the Centers for Medicare & Medicaid Services readmission reduction
program,” said Puebla Neira.
Others authors include UTMB’s En Shuo Hsu, Yong-Fang Kuo and Kenneth Ottenbacher.