Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Mar 19;21(1):248.
doi: 10.1186/s12913-021-06253-2.

Association between Medicare's Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share

Affiliations

Association between Medicare's Hospital Readmission Reduction Program and readmission rates across hospitals by medicare bed share

Souvik Banerjee et al. BMC Health Serv Res. .

Abstract

Background: Medicare's Hospital Readmissions Reduction Program (HRRP), implemented beginning in 2013, seeks to incentivize Inpatient Prospective Payment System (IPPS) hospitals to reduce 30-day readmissions for selected inpatient cohorts including acute myocardial infarction, heart failure, and pneumonia. Performance-based penalties, which take the form of a percentage reduction in Medicare reimbursement for all inpatient care services, have a risk of unintended financial burden on hospitals that care for a larger proportion of Medicare patients. To examine the role of this unintended risk on 30-day readmissions, we estimated the association between the extent of their Medicare share of total hospital bed days and changes in 30-day readmissions.

Methods: We used publicly available nationwide hospital level data for 2009-2016 from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare program, CMS Final Impact Rule, and the American Hospital Association Annual Survey. Using a quasi-experimental difference-in-differences approach, we compared pre- vs. post-HRRP changes in 30-day readmission rate in hospitals with high and moderate Medicare share of total hospital bed days ("Medicare bed share") vs. low Medicare bed share hospitals.

Results: We grouped the 1904 study hospitals into tertiles (low, moderate and high) by Medicare bed share; the average bed share in the three tertile groups was 31.2, 47.8 and 59.9%, respectively. Compared to low Medicare bed share hospitals, high bed share hospitals were more likely to be non-profit, have smaller bed size and less likely to be a teaching hospital. High bed share hospitals were more likely to be in rural and non-large-urban areas, have fewer lower income patients and have a less complex patient case-mix profile. At baseline, the average readmissions rate in the low Medicare bed share (control) hospitals was 20.0% (AMI), 24.7% (HF) and 18.4% (pneumonia). The observed pre- to post-program change in the control hospitals was - 1.35% (AMI), - 1.02% (HF) and - 0.35% (pneumonia). Difference in differences model estimates indicated no differential change in readmissions among moderate and high Medicare bed share hospitals.

Conclusions: HRRP penalties were not associated with any change in readmissions rate. The CMS should consider alternative options - including working collaboratively with hospitals - to reduce readmissions.

Keywords: Hospital performance-based penalty; Medicare bed share; Readmissions.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Trends in acute myocardial infarction, heart failure, and pneumonia 30-day risk adjusted readmission rates by Medicare bed share tertiles, 2009–2016. Notes: Effective HRRP start date is 2010 – the year in which the HRRP was enacted as part of the Affordable Care Act. Data sources: Authors’ analysis of Hospital Compare, 2009–2016; American Hospital Association Annual Survey, 2009; and Final Impact Rules, 2009–2016 data

Similar articles

Cited by

References

    1. Jha AK. To fix the hospital readmissions program, Prioritize What Matters. JAMA Forum. 2017. - PubMed
    1. Centers for Medicare & Medicaid Services. Hospital Readmissions Reduction Program. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpat.... Accessed 1 July 2019.
    1. Boccuti C, Casillas G. Aiming for fewer hospital U-turns: the Medicare hospital readmission reduction program. Menlo Park, CA: The Kaiser Family Foundation; 2017.
    1. Gerhardt G, Yemane A, Apostle K, Oelschlaeger A, Rollins E, Brennan N. Evaluating whether changes in utilization of hospital outpatient services contributed to lower Medicare readmission rate. Med Medicaid Res Rev. 2014;4(1):E1–E13. doi: 10.5600/mmrr.004.01.b03. - DOI - PMC - PubMed
    1. Gerhardt G, Yemane A, Hickman P, Oelschlaeger A, Rollins E, Brennan N. Medicare readmission rates showed meaningful decline in 2012. Medicare Medicaid Res Rev. 2013;3(2):mmrr.003.02.b01. - PMC - PubMed