Patient Readmission Rates For All Insurance Types After Implementation Of The Hospital Readmissions Reduction Program

Abstract

Since the implementation of the Hospital Readmissions Reduction Program (HRRP), readmissions have declined for Medicare patients with conditions targeted by the policy (acute myocardial infarction, heart failure, and pneumonia). To understand whether HRRP implementation was associated with a readmission decline for patients across all insurance types (Medicare, Medicaid, and private), we conducted a difference-in-differences analysis using information from the Nationwide Readmissions Database. We compared how quarterly readmissions for target conditions changed before (2010-12) and after (2012-14) HRRP implementation, using nontarget conditions as the control. Our results demonstrate that readmissions declined at a significantly faster rate after HRRP implementation not just for Medicare patients but also for those with Medicaid, both in the aggregate and for individual target conditions. However, composite Medicaid readmission rates remained higher than those for Medicare. Throughout the study period privately insured patients had the lowest aggregate readmission rates, which declined at a similar rate compared to nontarget conditions. The HRRP was associated with nationwide readmission reductions beyond the Medicare patients originally targeted by the policy. Further research is needed to understand the specific mechanisms by which hospitals have achieved reductions in readmissions.

Exhibit 2

Risk-adjusted readmission rates for three conditions targeted by the Hospital Readmissions Reduction Program (HRRP) from the first quarter of 2010 through the third quarter of 2014, by insurance type SOURCE Authors’ analysis of data for 2010–14 from the Nationwide Readmissions Database. NOTES The target conditions were acute myocardial infarction, heart failure, and pneumonia. The data shown represent the quarterly risk-adjusted readmission rates, account-ing for the effect of age, sex, and clinical comorbidities and using the fourth quarter of 2014 as the reference group. The dashed lines reflect projected risk-adjusted trends after the HRRP, assuming that pre-HRRP trends had continued. The solid lines represent the observed readmission trends. Solid lines were generated from the data through a piecewise linear model that included quarters, insurance type (“other” includes self-pay and uninsured patients), target condition, and the interaction terms among the three variables.

Exhibit 3

Risk-adjusted readmission rates for conditions not targeted by the Hospital Readmissions Reduction Program (HRRP) from the first quarter of 2010 through the third quarter of 2014, by insurance type SOURCE Authors’ analysis of data for 2010–14 from the Nationwide Readmissions Database. NOTES “Conditions not targeted” (“control conditions” in exhibits 1 and 4) are all but the three target conditions (acute myocardial infarction, heart failure, and pneumonia), as explained in the text. The data shown represent the quarterly risk-adjusted readmission rates as explained in the notes to exhibit 2. Solid lines were generated as explained in the notes to exhibit 2. “Other” includes self-pay and uninsured patients.