Quality improvement programs are often effective at reducing hospital readmissions, especially among patients with certain ailments. A new study published in the Journal of the American Medical Association, however, showed that slashing readmission rates may not actually save those hospitals money.
Reviewing data from more than 16,700 patients, it was clear that quality improvement initiatives do have an effect on hospitals' readmission rates; on average, they dropped about 12 percent for heart failure patients and roughly 6 percent for adults with a variety of other conditions.
Financially, though, that didn't translate into big savings. While hospitals did save about $972 per heart failure patient, they lost about $169 per patient when considering other illnesses. And since the costs were so varied, researchers couldn't definitively conclude whether that reflected an actual cost savings or not. In fact, in about 20 percent of the studies reviewed by the researchers, 20 percent of hospitals incurred net losses.
Perhaps complicating the picture is the cost of implementing a quality improvement program. Medicare is expected to save $8.2 billion from avoided readmissions under the Hospital Readmissions Reduction Program, but that doesn't include the program costs associated with quality improvement interventions, because those costs are not borne by Medicare.
Quality programs that supported a patient's capacity for self-care were generally more effective, and among the general population, they offered greater value; clinical effectiveness was about the same, but hospitals netted almost $8,300 more per patient. Because such quality improvement programs are focused on self-maintenance, they decrease reliance on the healthcare system. They also, however, increase the investments of labor by patients and caregivers.
Researchers struggled to determine whether quality improvement programs represented a good value overall, largely because readmissions only reflect health outcomes indirectly. Many readmissions, the authors wrote, are in the patients' best interests and are not ultimately avoidable.
In 2016, more than half of hospitals in the U.S. were penalized by the Centers for Medicare and Medicaid Services for their readmission rates.