Should We Care About Short-Term Readmissions After Percutaneous Coronary Intervention?

Since the publication of the landmark analysis in 2009 by Jencks et al1 demonstrating that one sixth of Medicare beneficiaries were readmitted within 30 days after hospitalization, accounting for billions of dollars in potentially preventable expenditures, reducing unplanned early rehospitalization has become a national priority.2 With the passage of the Affordable Care Act in 2010, the Centers for Medicare and Medicaid Services established the Hospital Readmissions Reduction Program, which incentivizes hospitals to curtail readmissions by penalizing those with excess 30-day readmission rates after index hospitalizations involving acute myocardial infarction, congestive heart failure, or pneumonia.3,4 The payment incentives were subsequently expanded in 2014 to include patients admitted with acute exacerbation of chronic obstructive pulmonary disease, total hip, or total knee arthroplasty and subsequently in 2015 to include patients admitted for coronary artery bypass grafting.4 Although the program has resulted in a decline in hospital readmissions among Medicare beneficiaries,5–7 there continues to be ongoing debate about the impact of hospital incentives for readmission reduction on overall patient outcomes, including mortality.8,9See Article by Tripathi et al Although readmissions after percutaneous coronary intervention (PCI) were not initially considered for measurement by the Hospital Readmissions Reduction Program, the recognition that PCI was 1 of 7 procedures accounting for a third of overall readmission costs with substantial variation between hospitals1 led the Centers for Medicare and Medicaid Services in 2013 to initiate voluntary reporting of risk-standardized readmission rates for National Cardiovascular Data Registry CathPCI registry participating hospitals as part of a pilot program.10 Although a hospital’s readmission rates were determined from Medicare fee-for-service claims, patient demographics and clinical variables were obtained by linkage to the CathPCI registry, a process that enabled more refined risk adjustment but precluded extension of the program …