Trends in Hospital Readmission of Medicare-Covered Patients With Heart Failure

Abstract

Background: The Medicare Hospital Readmissions Reduction Program has led to fewer readmissions following hospitalizations with a principal diagnosis of heart failure (HF). Patients with HF are frequently hospitalized for other causes.

Objectives: This study sought to compare trends in Medicare risk-adjusted, 30-day readmissions following principal HF hospitalizations and other hospitalizations with HF.

Methods: This was a retrospective study of 12,973,853 Medicare hospitalizations with a principal or secondary diagnosis of HF between January 2008 and June 2015. Hospitalizations were categorized as follows: principal HF hospitalizations; principal acute myocardial infarction or pneumonia hospitalizations with secondary HF; and other hospitalizations with secondary HF. The study examined trends in risk-adjusted, 30-day, all-cause readmission rates for each cohort and trends in differences in readmission rates among cohorts by using linear spline regression models.

Results: Before passage of the Affordable Care Act in March 2010, risk-adjusted, 30-day readmission rates were stable for all 3 cohorts, with mean monthly rates of 26.1%, 24.9%, and 24.4%, respectively. Risk-adjusted readmission rates started declining after passage of the Affordable Care Act by 1.09% (95% confidence interval [CI]: 0.51% to 1.68%), 1.24% (95% CI: 0.92% to 1.57%), and 1.05% (95% CI: 0.52% to 1.58%) per year, respectively, until implementation of the Hospital Readmissions Reduction Program in October 2012 and then stabilized for all 3 cohorts.

Conclusions: Patients with HF are often hospitalized for other causes, and these hospitalizations have high readmission rates. Policy changes led to decreases in readmission rates for both principal and secondary HF hospitalizations. Readmission rates in both groups remain high, suggesting that initiatives targeting all hospitalized patients with HF continue to be warranted.

Keywords: Medicare; heart failure; hospitalizations; outcomes.

Figure 1.. Trends in adjusted readmission rates for hospitalizations with heart failure.

Cohort 1 represents hospitalizations with a principal diagnosis of HF; cohort 2, hospitalizations with a principal acute myocardial infarction (AMI) or pneumonia with a secondary diagnosis of HF; cohort 3, hospitalizations with a principal diagnosis other than HF, AMI, or pneumonia and a secondary diagnosis of HF. For each cohort, the circles represent the risk-adjusted 30-day readmission rate for a given month and the lines represent fitted regression lines of those rates, with shading for 95% confidence intervals. Vertical lines represent introduction of the Affordable Care Act (ACA) in March 2010 and the Hospital Readmission Reduction Program (HRRP) in October 2012.

Central Illustration. Trends in Readmissions for Patients with Heart Failure in the Medicare Population. Hospitalized patients with heart failure (HF) were categorized into cohort based on principal diagnosis. Hospitalizations with a principal diagnosis of HF, hospitalizations with a principal diagnosis of acute myocardial infarction (AMI) or pneumonia and a secondary diagnosis of HF, and hospitalizations with a principal diagnosis other than HF, AMI, or pneumonia and a secondary diagnosis of HF all had similar reductions in adjusted readmission rates following introduction of the Affordable Care Act (ACA) followed by a relative increase in readmission rates following introduction of the Hospital Readmission Reduction Program (HRRP). Readmission rates were similar throughout the period for all three cohorts.