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Health Aff (Millwood). 2019 Apr;38(4):585-593. doi: 10.1377/hlthaff.2018.05412.

Patient Readmission Rates For All Insurance Types After Implementation Of The Hospital Readmissions Reduction Program.

Author information

1
Enrico G. Ferro is a fellow at the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, and a resident physician in internal medicine at Brigham and Women's Hospital, in Boston, Massachusetts.
2
Eric A. Secemsky is a cardiologist at the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.
3
Rishi K. Wadhera is a fellow at the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, and in the Heart and Vascular Center, Department of Medicine, at Brigham and Women's Hospital.
4
Eunhee Choi is a statistician at the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.
5
Jordan B. Strom is a cardiologist at the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.
6
Jason H. Wasfy is a cardiologist in the Department of Medicine at Massachusetts General Hospital, in Boston.
7
Yun Wang is a senior research scientist in the Department of Biostatistics at the Harvard T. H. Chan School of Public Health, in Boston.
8
Changyu Shen is lead statistician at the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.
9
Robert W. Yeh (ryeh@bidmc.harvard.edu) is the director of the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.

Abstract

Since the implementation of the Hospital Readmissions Reduction Program (HRRP), readmissions have declined for Medicare patients with conditions targeted by the policy (acute myocardial infarction, heart failure, and pneumonia). To understand whether HRRP implementation was associated with a readmission decline for patients across all insurance types (Medicare, Medicaid, and private), we conducted a difference-in-differences analysis using information from the Nationwide Readmissions Database. We compared how quarterly readmissions for target conditions changed before (2010-12) and after (2012-14) HRRP implementation, using nontarget conditions as the control. Our results demonstrate that readmissions declined at a significantly faster rate after HRRP implementation not just for Medicare patients but also for those with Medicaid, both in the aggregate and for individual target conditions. However, composite Medicaid readmission rates remained higher than those for Medicare. Throughout the study period privately insured patients had the lowest aggregate readmission rates, which declined at a similar rate compared to nontarget conditions. The HRRP was associated with nationwide readmission reductions beyond the Medicare patients originally targeted by the policy. Further research is needed to understand the specific mechanisms by which hospitals have achieved reductions in readmissions.

PMID:
30933582
DOI:
10.1377/hlthaff.2018.05412

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