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. 2017 Mar 7;166(5):324-331.
doi: 10.7326/M16-0185. Epub 2016 Dec 27.

Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre-Post Analysis

Jason H Wasfy  1 , Corwin Matthew Zigler  1 , Christine Choirat  1 , Yun Wang  1 , Francesca Dominici  1 , Robert W Yeh  1
Affiliations

Readmission Rates After Passage of the Hospital Readmissions Reduction Program: A Pre-Post Analysis

Jason H Wasfy et al. Ann Intern Med. .

Abstract

Background: Whether hospitals with the highest risk-standardized readmission rates (RSRRs) subsequently experienced the greatest improvement after passage of the Medicare Hospital Readmissions Reduction Program (HRRP) is unknown.

Objective: To evaluate whether passage of the HRRP was followed by acceleration in improvement in 30-day RSRRs after hospitalizations for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia and whether the lowest-performing hospitals had faster acceleration in improvement after passage of the law than hospitals that were already performing well.

Design: Pre-post analysis stratified by hospital performance groups.

Setting: U.S. acute care hospitals.

Patients: 15 170 008 Medicare patients discharged alive from 2000 to 2013.

Intervention: Passage of the HRRP.

Measurements: 30-day readmission rates after hospitalization for AMI, CHF, or pneumonia for hospitals in the highest-performance (0% penalty), average-performance (>0% and <0.50% penalty), low-performance (≥0.50% and <0.99% penalty), and lowest-performance (≥0.99% penalty) groups.

Results: Of 2868 hospitals serving 1 109 530 Medicare discharges annually, 30.1% were highest performers, 44.0% were average performers, 16.8% were low performers, and 9.0% were lowest performers. After controlling for prelaw trends, an additional 67.6 (95% CI, 66.6 to 68.4), 74.8 (CI, 74.0 to 75.4), 85.4 (CI, 84.0 to 86.8), and 95.1 (CI, 92.6 to 97.5) readmissions per 10 000 discharges were found to have been averted per year in the highest-, average-, low-, and lowest-performance groups, respectively, after passage of the law.

Limitation: Inability to distinguish between improvement caused by the magnitude of the penalty or by different levels of health improvement in different patient populations.

Conclusion: After passage of the HRRP, 30-day RSRRs for myocardial infarction, heart failure, and pneumonia decreased more rapidly than before the law's passage. Improvement was most marked for hospitals with the lowest prelaw performance.

Primary funding source: National Institutes of Health.

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Figures

Figure 1
Figure 1
Timeline of Medicare public reporting, passage of health reform, and financial penalties. CMS = Centers for Medicare & Medicaid Services; HRRP = Hospital Readmissions Reduction Program.
Figure 2
Figure 2
Included and excluded hospitals (top) and patients (bottom). Hospitals not on the penalty list and those that did not exist during the entire study period were excluded.
Figure 3
Figure 3
Estimated RSRRs, by quarter and by performance group, for all 3 conditions combined. Lines represent smoothed trends over time. The vertical dashed line is placed at the intervention point (31 March 2010). Q1 = first quarter; RSRR = risk-standardized readmission rate.
See this image and copyright information in PMC

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