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Am J Med. 2018 Nov;131(11):1324-1331.e14. doi: 10.1016/j.amjmed.2018.06.013. Epub 2018 Sep 7.

Trends in 30-Day Readmission Rates for Medicare and Non-Medicare Patients in the Era of the Affordable Care Act.

Author information

1
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn.
2
Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Tex.
3
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
4
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Clover Health, Jersey City, NJ.
5
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
6
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of General Pediatrics, Department of Pediatrics, Yale School of Medicine, New Haven, Conn.
7
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Department of Population Health, Department of Medicine, Division of Healthcare Delivery Science, and Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY.
8
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Department of Health Policy and Management, Yale School of Public Health, New Haven, Conn. Electronic address: harlan.krumholz@yale.edu.

Abstract

BACKGROUND:

Temporal changes in the readmission rates for patient groups and conditions that were not directly under the purview of the Hospital Readmissions Reduction Program (HRRP) can help assess whether efforts to lower readmissions extended beyond targeted patients and conditions.

METHODS:

Using the Nationwide Readmissions Database (2010-2015), we assessed trends in all-cause readmission rates for 1 of the 3 HRRP conditions (acute myocardial infarction, heart failure, pneumonia) or conditions not targeted by the HRRP in age-insurance groups defined by age group (≥65 years or <65 years) and payer (Medicare, Medicaid, or private insurance).

RESULTS:

In the group aged ≥65 years, readmission rates for those covered by Medicare, Medicaid, and private insurance decreased annually for acute myocardial infarction (risk-adjusted odds ratio [OR; 95% confidence interval] among Medicare patients, 0.94 [0.94-0.95], among Medicaid patients, 0.93 [0.90-0.97], and among patients with private-insurance, 0.95 [0.93-0.97]); heart failure (ORs, 0.96 [0.96-0.97], 0.96 [0.94-0.98], and 0.97 [0.96-0.99], for the 3 payers, respectively), and pneumonia (ORs, 0.96 [0.96-0.97), 0.94 [0.92-0.96], and 0.96 [0.95-0.97], respectively). Readmission rates also decreased in the group aged <65 years for acute myocardial infarction (ORs: Medicare 0.97 [0.96-0.98], Medicaid 0.94 [0.92-0.95], and private insurance 0.93 [0.92-0.94]), heart failure (ORs, 0.98 [0.97-0.98]: 0.96 [0.96-0.97], and 0.97 [0.95-0.98], for the 3 payers, respectively), and pneumonia (ORs, 0.98 [0.97-0.99], 0.98 [0.97-0.99], and 0.98 [0.97-1.00], respectively). Further, readmission rates decreased significantly for non-target conditions.

CONCLUSIONS:

There appears to be a systematic improvement in readmission rates for patient groups beyond the population of fee-for-service, older, Medicare beneficiaries included in the HRRP.

KEYWORDS:

Medicaid; Medicare; Private insurance; Readmissions; Trends

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