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The Affordable Care Act, among many other things, created the Hospital Readmission Reduction Program, which penalized Medicare reimbursement to hospitals with higher 30-day readmission rates for three common diseases: heart failure, acute myocardial infarction, and pneumonia. The motivation for the program was pretty clear: improve the quality of care by tying reimbursement to good care practices.

Of course, any policy like this may have unintended consequences. A hospital might try to avoid readmitting people that really need to be hospitalized – sending them home from the ER, for example. Or a hospital might hold on to patients longer in the first place, prolonging length of stay to be sure that the patients are really 100% ready for discharge, which would drive up costs and potentially increase the risk of nosocomial disasters.

Most concerningly, individuals who die during the first hospitalization can't be readmitted. You don’t want to inadvertently incentivize practices that trade deaths for readmissions.

This week, a study appearing in the Journal of the American Medical Association gives us the best look yet into the real effects the HRRP has had on patient outcomes.