Encore! EP326: The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP

The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP (Encore! EP326)

In this Encore, Stacey Richter revisits her conversation with Rishi Wadhera, MD, MPP, a cardiologist at Beth Israel Deaconess Medical Center, about why the Hospital Readmissions Reduction Program (HRRP) may be doing more harm than good — and how Goodhart's Law explains why.

WHAT YOU'LL LEARN

✅ What Goodhart's Law is: "When a measure becomes a target, it ceases to be a good measure"

✅ Why the 30-day readmission measure at the heart of HRRP is an incomplete, yes-no measure of hospital quality

✅ Why HRRP has disproportionately penalized hospitals serving poorer, more disadvantaged communities

✅ Why blunt, nationally rolled-out policies elicit mixed behavioral responses that policymakers should rigorously test first

✅ What a better approach to quality improvement might look like instead of anchoring it so tightly to payment

WHY THIS MATTERS

HRRP was designed to incentivize better discharge planning and follow-up care, but Dr. Wadhera's research shows it instead became a textbook case of Goodhart's Law — a blunt, poorly risk-adjusted policy that penalizes hospitals for factors like poverty and housing instability that are entirely outside their control. Two recent JAMA pieces now call for CMS to retire the policy altogether.

MENTIONED IN THIS EPISODE

Encore! EP295 with Rebecca Etz, PhD: Apple Podcasts | Spotify (pod.link, unconfirmed — Spotify outage) | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction

03:30 What was the Hospital Readmissions Reduction Program intended to do?

05:22 Why did CMS think some readmissions were preventable?

06:02 "The spirit of the HRRP was to incentivize hospitals to improve…discharge planning, transitions of care, and post-discharge follow-up."

06:58 How has research in the last few years changed thinking on the effectiveness of HRRP?

08:16 "The 30-day readmission measure — it's an incomplete measure."

11:48 "I think patients…are smart, and they know what's going on."

13:34 "What's happening is, we're just increasing the number of times they need to come back to the ER within that 30-day period."

13:55 "The weird thing about the HRRP is that when it evaluates hospitals' 30-day readmission rates, it's a yes-no phenomenon."

15:03 "What CMS does is, it risk adjusts…and that is what we should be doing."

18:30 "This program has been incredibly regressive."

19:04 "Poverty, neighborhood disadvantage, housing instability — these factors are out of hospitals' control."

21:50 "Blunt policies like this that are rolled out nationally probably elicit mixed behavioral responses."

22:06 "It just makes no sense to take resources away from hospitals."

22:32 Encore EP295 with Rebecca Etz, PhD, of The Larry A. Green Center.

23:47 What's the way to improve quality of care globally?

25:37 "CMS's approach to improving quality of care has really anchored…that to payment."

26:08 "It's time for us to rethink what our approach to quality improvement should be."

29:22 "Policy makers have an obligation to rigorously test the impact of these types of policies before they roll them out nationally."

31:41 Can you scale healthcare nationally?