Unintended consequences of well-intentioned health policy: hospital readmissions

The danger of unintended consequences lurks in every policy move in healthcare. However, this one seems fairly predictable. Although well intentioned, an ACA policy called the Hospital Readmissions Reduction Program began imposing financial penalties on hospitals with high readmission rates within 30 days of a hospitalization for pneumonia, heart attack or congestive heart failure. This at first appeared to produce the intended beneficial effect: readmission rates declined and Medicare saved a reported $10 dollars. But new research paints a different picture. Hospitals seem to have to avoid “admissions” by keeping returning sick patients in the ER or in Observation Units; hospitals serving the poor and vulnerable received the biggest share of the financial penalties; and the end result may be that readmission rates declined but mortality increased. Maybe the program needs a few tweaks. But more likely we believe these types of policy changes are forever vulnerable to gaming by providers. The missing element here in our experience is that the policy failed to leverage the consumer in the process of change. In looking at policy changes ask whether the patient will understand it and whether the patient can influence the decisions and vote with her feet. That is when hospitals and provides pay attention and respond.

Read NYT: Did This Health Care Policy Do Harm?

Read Jama Network: Association of the Hospital Readmissions Reduction Program With Mortality…

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