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. 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

Suveen Angraal  1 , Rohan Khera  2 , Shengfan Zhou  1 , Yongfei Wang  3 , Zhenqiu Lin  1 , Kumar Dharmarajan  4 , Nihar R Desai  3 , Susannah M Bernheim  5 , Elizabeth E Drye  6 , Khurram Nasir  3 , Leora I Horwitz  7 , Harlan M Krumholz  8
Affiliations

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

Suveen Angraal et al. Am J Med. 2018 Nov.

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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Figures

Fig 1
Figure 1
Trends of readmission rates in patients aged ≥65 years by different payer types.
Fig 2
Figure 2
Trends of readmission rates in patients aged <65 years by different payer types.
Fig 3
Supplementary Figure 1.
Patient Selection Flowsheet. AMI= acute myocardial infarction; COPD= chronic obstructive pulmonary disease; HF= heart failure; H/K= hip/knee replacement; NRD= National Readmission Database; PN= pneumonia
Fig 4
Supplementary Figure 2.
Risk-Adjusted Odds Ratios for Yearly Change in Readmission Rates, According to Different Age-Payer Groups. CI= confidence interval; OR= odds ratio
See this image and copyright information in PMC

References

    1. Patient Protection and Affordable Care Act, 42 USC § 18001 (2010).
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