The CMS' long-standing hospital readmissions penalty program has taken quite a beating recently from members of the research community over problems with its underlying measures.
But while criticism of the program has escalated, not everyone has joined the bandwagon. Dr. Harlan Krumholz, a well-known researcher at Yale New Haven Health, passionately defends the measures, and with good reason: He led the group that helped the CMS develop the readmission measures as part of a multimillion-dollar contract the agency gave to the academic healthcare institution.
Still, dissatisfaction with the way the readmissions program is designed is coming to a head, and possibly has exposed some fundamental flaws with not just the readmissions program but the CMS' measure-designing process, including those found on Hospital Compare and part of the CMS' value-based purchasing programs.
“I think the measures we end up with are a function of the process we use for the development of these measures … and none of the processes that we use are really particularly good,” said Francois de Brantes, senior vice president of commercial business development at healthcare consultancy Remedy Partners who has experience bidding for CMS contracts.
Drawing attention to the CMS' Hospital Readmissions Reduction Program in the past month were two studies published in different journals. One—published in late December in JAMA—found mortality rates rose slightly among heart failure and pneumonia patients after the readmissions program went into effect, mirroring another study published in November 2017 that came to similar conclusions.
The other recent study—published this month in Health Affairs—found that reductions in readmissions rates may be related to coding changes the CMS made around the time the program was implemented. This was the second study in the past year to suggest that the reductions in readmissions may have been overestimated.