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Med Care. 2019 Dec;57(12):968-976. doi: 10.1097/MLR.0000000000001207.

Relative Effects of the Hospital Readmissions Reduction Program on Hospitals That Serve Poorer Patients.

Author information

1
Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
2
Swiss Data Science Center, ETH Zurich and EPFL, Lausanne, Switzerland.
3
Department of Biostatistics, Harvard T.H. Chan School of Public Health.
4
The Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School.
5
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Abstract

IMPORTANCE:

Hospitals that serve poorer populations have higher readmission rates. It is unknown whether these hospitals effectively lowered readmission rates in response to the Hospital Readmissions Reduction Program (HRRP).

OBJECTIVE:

To compare pre-post differences in readmission rates among hospitals with different proportion of dual-eligible patients both generally and among the most highly penalized (ie, low performing) hospitals.

DESIGN:

Retrospective cohort study using piecewise linear model with estimated hospital-level risk-standardized readmission rates (RSRRs) as the dependent variable and a change point at HRRP passage (2010). Economic burden was assessed by proportion of dual-eligibles served.

SETTING:

Acute care hospitals within the United States.

PARTICIPANTS:

Medicare fee-for-service beneficiaries aged 65 years or older discharged alive from January 1, 2003 to November 30, 2014 with a principal discharge diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia.

MAIN OUTCOME AND MEASURE:

Decrease in hospital-level RSRRs in the post-law period, after controlling for the pre-law trend.

RESULTS:

For AMI, the pre-post difference between hospitals that service high and low proportion of dual-eligibles was not significant (-65 vs. -64 risk-standardized readmissions per 10000 discharges per year, P=0.0678). For CHF, RSRRs declined more at high than low dual-eligible hospitals (-79 vs. -75 risk-standardized readmissions per 10000 discharges per year, P=0.0006). For pneumonia, RSRRs declined less at high than low dual-eligible hospitals (-44 vs. -47 risk-standardized readmissions per 10000 discharges per year, P=0.0003). Among the 742 highest penalized hospitals and all conditions, the pre-post decline in rate of change of RSRRs was less for high dual-eligible hospitals than low dual-eligible hospitals (-68 vs. -74 risk-standardized readmissions per 10000 discharges per year for AMI, -88 vs. -97 for CHF, and -47 vs. -56 for pneumonia, P<0.0001 for all).

CONCLUSIONS AND RELEVANCE:

For all hospitals, differences in pre-post trends in RSRRs varied with disease conditions. However, for the highest-penalized hospitals, the pre-post decline in RSRRs was greater for low than high dual-eligible hospitals for all penalized conditions. These results suggest that high penalty, high dual-eligible hospitals may be less able to improve performance on readmission metrics.

PMID:
31567860
PMCID:
PMC6856430
[Available on 2020-12-01]
DOI:
10.1097/MLR.0000000000001207

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