NCDR Study: No Change in Racial Disparities in MI Outcomes Following HRRP Implementation

Racial disparities in 30-day readmission and mortality rates among Medicare beneficiaries hospitalized with myocardial infarction (MI) did not change following implementation of the Centers for Medicare and Medicaid Services (CMS) Hospital Readmissions Reduction Program (HRRP), according to a study published in JAMA Cardiology.

Ambarish Pandey, MD, MSCS, et al., used data from ACC's Chest Pain – MI Registry to assess trends in 30-day readmission and mortality rates among black and nonblack patients hospitalized for MI from 2008 through 2016. The researchers used CMS claims data to determine 30-day all-cause readmission and mortality rates and stratified results by hospital performance category, defined as low vs. high performing based on HRRP readmission penalty status.

The final study cohort comprised 155,397 patients with MI treated at 753 hospitals. Of all patients, 11,280 (7.3 percent) were black. Of the 753 hospitals, 399 (53 percent) were categorized as high performing. During the study period, there was a steady decline in 30-day readmission rates among both black (20.8 percent in 2009 vs. 17.4 percent in 2016) and nonblack patients (17.9 percent vs. 14.5 percent). Black patients had higher unadjusted odds of 30-day readmission in both low- and high-performing hospitals, however these differences were attributable to clinical characteristics and disease severity.

During the study period, there were significant declines in 30-day mortality among nonblack patients in both low- and high-performing hospitals, while 30-day mortality remained stable among black patients. Among black patients, mortality declined in low-performing hospitals but not in high-performing hospitals, with no significant changes based on HRRP implementation.

According to the researchers, the study's findings may "potentially allay concerns that penalizing low-performing hospitals with reduced CMS payments under HRRP has led to worsening racial disparities in clinical outcomes." They conclude that HRRP implementation "has not been associated with worsening or improvement in these racial differences in 30-day outcomes."

In an accompanying editorial comment, Martha J. Radford, MD, FACC, writes that the study "sheds light on possible reasons for the unwavering racial disparity in readmission rates," noting that black patients have higher prevalence of diabetes, hypertension, heart failure and other clinical risk factors. Moving forward, she suggests an "adjustment of therapeutic decisions to reflect individual patient needs, including (for some patients) the need for readmission."

Pandey A, Keshvani N, Khera R, et al. JAMA Cardiol 2020;Jan 8:[Published online before print].