“It is unclear whether the reductions seen represent improved care quality or instead gaming by hospitals, such as delaying readmissions just beyond 30 days or merely reclassifying a readmission from inpatient status to outpatient observation status,” he said. “Most critically, this study did not evaluate whether there were unintended consequences of increased mortality or worse health status as a result of the CMS penalty program.”

“Further studies are needed to determine the impact of the readmission penalties and whether they should be replaced with more patient-centered and meaningful measures,” Dr. Fonarow said.

Dr. Michael Pat Thompson from University of Tennessee Health Science Center in Memphis recently questioned the reliability of the 30-day readmission measures used in the HRRP. He told Reuters Health by email, “The success of the HRRP, as demonstrated in this report, ensures that reducing readmissions will continue to be a policy objective. But, more generally, I think the success of the HRRP solidifies pay-for-performance as a method that will be used by policymakers to stimulatequality improvement in hospitals.”

“Despite the successes of the HRRP, the long-term effects of financial penalties on hospitals, and the patients they serve, remains to be seen,” he said. “We should be particularly concerned about the combined financial impact of multiple penalties and the fact that relative quality targets results in persistent penalties for many hospitals.This is particularly concerning forsafety-net hospitals, who have been disproportionately penalized by the HRRP.”

“Additionally,” Dr. Thompson said, “understanding exactly how hospitals are reducing readmissions, including where patients may be going instead of readmitting and whether changes in healthcare delivery are better for patients, are critically important when evaluating the overall impact of the HRRP.”

Dr. David L. Chin from University of California, Davis’s Center for Healthcare Policy and Research in Sacramento told Reuters Health by email, “The HRRP appears to influence 30-day readmission rates after adjusting for patient and hospital characteristics, particularly among lower-performing facilities. However, the sustainability of this policy’s effect is unknown.”