If you are sick and need to be readmitted to the hospital after already spending time there, your chances of being allowed back in have dropped since the weight of federal law has imposed penalties on readmissions under the Affordable Care Act, in an effort to contain costs that have ballooned out of control with almost 11 million new people on Medicaid rather than in private exchanges.

The authors of the analysis are cheering this as policy efforts that  motivate health care providers to improve performance but they didn't actually analyze successful medical treatment, they simply used the metric of readmission.

The Hospital Readmission Reduction Program was enacted into law in 2010 and implemented in 2012 to penalize hospitals if patients who were readmitted within 30 days of their initial discharge from the hospital after treatment for several common conditions, including heart failure, pneumonia and acute myocardial infarction.  This was in response to wide variation in hospitals' readmission rates, suggesting that patients admitted to certain hospitals were more likely to experience readmissions compared to other hospitals. In other words, hospitals were too freely admitting people to make money.

Yet some readmissions may be unavoidable, and some hospitals serve patients more likely to be readmitted because they are in worse health. To advocate for their belief that punitive actions have caused hospitals to be more efficient, the authors examined Medicare fee-for-service hospitalization data from more than 2,800 hospitals across the country between 2000 and 2013 to evaluate whether passage of the federal law was followed by acceleration in improvement in 30-day risk-standardized readmission rates after initial hospitalization for acute myocardial infraction, congestive heart failure or pneumonia.

Hospitals were categorized into one of four groups based on the penalties they had incurred under the Hospital Readmission Reduction Program: highest performance (0% penalty), average performance (greater than 0% but less than 0.5% penalty), low performance (equal to or greater than 0.5% but less than 0.99% penalty), and lowest performance (greater than or equal to 0.99% penalty).

The data showed all groups of hospitals improved to some degree, but the hospitals that were the lowest performers before passage of federal reform had the highest improvement after being penalized financially. In other words, they had fewer readmissions. 

Did that actually help or hurt patients? They didn't examine that. The goal was to preserve the bottom line, exactly the criticism that medical care faced up until 2009.