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. 2020 Oct;21(10):1504-1508.e1.
doi: 10.1016/j.jamda.2020.05.018. Epub 2020 Jul 11.

Hospital Readmissions Reduction Program and Post-Acute Care: Implications for Service Delivery and 30-Day Hospital Readmission

Chih-Ying Li  1 , Amol Karmarkar  2 , Yu-Li Lin  3 , Yong-Fang Kuo  4 , Kenneth J Ottenbacher  5
Affiliations

Hospital Readmissions Reduction Program and Post-Acute Care: Implications for Service Delivery and 30-Day Hospital Readmission

Chih-Ying Li et al. J Am Med Dir Assoc. 2020 Oct.

Abstract

Objectives: Examine whether the introduction of the Hospital Readmissions Reduction Program (HRRP) is associated with changes in post-acute care (PAC) use and 30-day readmission.

Design: A retrospective cohort study examined data prepassage, preimplementation, and postimplementation of the HRRP.

Setting and participants: In total, 7,851,430 Medicare beneficiaries discharged from 5116 acute hospitals to PAC settings including inpatient rehabilitation, skilled nursing, home health, or a long-term care hospital during 2007‒2015. We examined HRRP-targeted conditions (acute myocardial infarction, heart failure, and pneumonia) and nontargeted conditions (ischemic stroke, total hip arthroplasty/total knee arthroplasty, and hip/femur fractures).

Measures: The hospital-level of quarterly PAC use and the association with 30-day risk-standardized readmission rates. Outcomes were calculated for HRRP-targeted and nontargeted conditions/diagnoses across 3 phases of HRRP implementation.

Results: An increase in quarterly PAC use was significantly (P < .001) associated with a decrease in 30-day risk-standardized readmission rates for acute myocardial infarction, heart failure, and hip/femur fracture. In contrast, an increase in quarterly PAC use was significantly associated with an increase in readmission rate for total hip arthroplasty/total knee arthroplasty (P < 001). PAC quarterly use and readmission rates varied significantly during implementation periods for HRRP- targeted and nontargeted conditions.

Conclusions and implications: The impact on readmission after PAC for selected impairment groups may be mediated by the type of PAC services received and whether the diagnoses is included in the HRRP. Additional research is necessary to determine if a reduction in readmission is associated with inclusion in the HRRP or is a side effect related to diagnostic group and/or type of PAC services received.

Keywords: Hospital Readmissions Reduction Program; Subacute care; patient readmission.

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Conflict of interest statement

Conflicts of Interest:

All authors declare that they had no conflicts of interest in any regard with respect to publishing this paper.

Figures

Figure 1.
Figure 1.. Timeline of policies and study cohort relevant to Hospital Readmissions Reduction Program.
Figure 1 demonstrates timeline of policies and three period (A, B and C) relevant to Hospital Readmissions Reduction Program in the study. Abbreviations: HRRP: Hospital Readmissions Reduction Program. THA/TKA: Total Hip Arthroplasty/Total Knee Arthroplasty.
See this image and copyright information in PMC

References

    1. Centers for Medicare and Medicaid Services. Hospital Readmissions Reduction Program (HRRP). Available at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpat... Accessed January 5, 2018.
    1. Medicare Payment Advisory Commission. Report to the Congress: “Chapter 1: mandated report: the effects of the Hospital Readmissions Reduction Program”. Available at: http://www.medpac.gov/docs/default-source/reports/jun18_ch1_medpacreport... Accessed July 13, 2018
    1. U.S. Department of Health and Human Services. New HHS data shows major strides made in patient safety, leading to improved care and savings. Available at: http://innovation.cms.gov/Files/reports/patient-safety-results.pdf Accessed January 21, 2016.
    1. Henry J Kaiser Family Foundation. Aiming for fewer hospital U-turns: the Medicare Hospital Readmission Reduction Program. Available at: https://www.kff.org/medicare/issue-brief/aiming-for-fewer-hospital-u-tur... Accessed October 5, 2018.
    1. Berenson RA, Paulus RA, Kalman NS. Medicare’s readmissions reduction program - a positive alternative. N Engl J Med. 2012;366:1364–6. doi:10.1056/NEJMp1201268. - DOI - PubMed

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