Study: Hospitals incorrectly penalized by CMS’ Hospital Readmission Reduction Program

A new study published Oct. 14 in JAMA Cardiology is highlighting flaws in the Centers for Medicare & Medicaid Services’ Hospital Readmission Reduction Program that resulted in inappropriate penalties on hospitals or, in some cases, overlooking hospitals that should have been penalized.

By evaluating three of the program’s six conditions – acute myocardial infarction, pneumonia and heart failure – the study’s authors found that the program incorrectly penalizes hospitals due to margins of error associated with the 30-day risk-adjusted readmission measure on which the program relies. As a result, 20.9% of hospitals should have been penalized for their readmission rates for acute myocardial infarction but weren't, while 13.5% should have received a penalty for their readmission rate for heart failure and 13.2% for their readmission rate for pneumonia.

On the other hand, more than 10% of hospitals received penalties for readmissions performance for acute myocardial infarction but shouldn't have; 10.9% were incorrectly penalized for heart failure and 12.3% for pneumonia. The authors estimate that the data reporting periods to achieve a misclassification rate of 20% would have to be increased to six years for the pneumonia readmissions measure and 12 years for the AMI measure.