Author + information
- Received January 2, 2019
- Revision received July 8, 2019
- Accepted July 29, 2019
- Published online October 9, 2019.
- Mitchell A. Psotka, MD, PhDa,∗ (, )@mpsotka,
- Gregg C. Fonarow, MDb,
- Larry A. Allen, MD, MHSc,
- Karen E. Joynt Maddox, MD, MPHd,
- Mona Fiuzat, PharmDe,
- Paul Heidenreich, MD, MSf,
- Adrian F. Hernandez, MD, MHSg,
- Marvin A. Konstam, MDh,
- Clyde W. Yancy, MD, MSci and
- Christopher M. O'Connor, MDa
- aInova Heart and Vascular Institute, Falls Church, Virginia
- bAhmanson–UCLA Cardiomyopathy Center, University of California Los Angeles, Los Angeles, California
- cDivision of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
- dWashington University School of Medicine, St. Louis, Missouri
- eDepartment of Medicine, Duke University School of Medicine, Durham, North Carolina
- fMedical Service, VA Palo Alto Health Care System, Palo Alto, California
- gDuke Clinical Research Institute, Durham, North Carolina
- hCardioVascular Center, Tufts Medical Center, Boston, Massachusetts
- iDivision of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Mitchell A. Psotka, Inova Heart and Vascular Institute, 3300 Gallows Road, Falls Church, Virginia 22042.
The mandatory federal pay-for-performance Hospital Readmissions Reduction Program (HRRP) was created to decrease 30-day hospital readmissions by instituting accountability and stimulating quality care and coordination, particularly during care transitions. The HRRP has changed the landscape of hospital readmissions and reimbursement within the United States by imposing substantial Medicare payment penalties on hospitals with higher-than-expected readmission rates. However, the HRRP has been controversial since its inception, particularly in the field of heart failure. Proponents argue that it has reduced national readmission rates, in part by raising awareness and investment in mechanisms to better assist patients during discharge and transitions; opponents contend that it unfairly penalizes hospitals for issues beyond their control, has unintended negative consequences due to incentivizing readmission over survival, that it encourages “gaming” the system, was not tested before implementation, and that it does not specify how hospitals can improve their performance. This paper incorporates the diverse, nuanced, and sometimes divergent interpretations presented during a multifaceted expert clinician discussion regarding the HRRP and heart failure; in cases in which consensus opinions were achieved, they are presented, including regarding potential new iterations of the HRRP for the future. Potential improvements include more comprehensive incorporation of outcomes into the HRRP measure and better risk adjustment to improve equality and fairness.
Dr. Psotka has received consulting fees from Amgen, Cytokinetics, and Roivant. Dr Fonarow has received consulting fees from Abbott, Amgen, Bayer, Janssen, Medtronic, and Novartis. Dr. Allen has received research support from the Patient-Centered Outcomes Research Institute, the National Institutes of Health, and the American Heart Association; and consulting fees from Boston Scientific and Cytokinetics. Dr. Joynt Maddox has received research support from the National Heart, Lung, and Blood Institute (K23HL109177-03); and is a former employee of the U.S. Department of Health and Human Services, where she continues work on a limited basis as a contractor. Dr. Hernandez has received research support from AstraZeneca, Bayer, Luitpold, GlaxoSmithKline, Merck, Novartis, Portola Pharmaceuticals, and Verily; and honoraria from Amgen, Bayer, Boehringer Ingelheim, Boston Scientific, MyoKardia, Novartis, and Sanofi. Dr. O’Connor has received research funding from and has served as a consultant to ResMed, Merck, and Bristol-Myers Squibb; has served as a consultant to Stealth Peptides; and is a co-owner of BisCardia. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. John Teerlink, MD, served as Guest Editor for this paper.
- Received January 2, 2019.
- Revision received July 8, 2019.
- Accepted July 29, 2019.
- 2019 American College of Cardiology Foundation
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