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
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References
- Hospital Readmissions Reduction Program (HRRP).(Available at:)https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.htmlDate accessed: January 5, 2018
- 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_sec.pdf?sfvrsn=0Date accessed: July 13, 2018
- 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.pdfDate accessed: January 21, 2016
- Aiming for fewer hospital U-turns: The Medicare Hospital Readmission Reduction Program.(Available at:)
- Medicare's readmissions reduction program: A positive alternative.N Engl J Med. 2012; 366: 1364-1366
- Readmissions, observation, and the Hospital Readmissions Reduction Program.N Engl J Med. 2016; 374: 1543-1551
- Readmission rates in not-for-profit vs proprietary hospitals before and after the Hospital Readmission Reduction Program implementation.BMC Health Serv Res. 2018; 18: 31
- Medicare readmission rates showed meaningful decline in 2012.Medicare Medicaid Res Rev. 2013; 28: 3
- Association of coded severity with readmission reduction after the Hospital Readmissions Reduction Program.JAMA Intern Med. 2018; 178: 290-292
- Readmission rates after passage of the Hospital Readmissions Reduction Program: A pre-post analysis.Ann Intern Med. 2017; 166: 324-331
- Patient Protection and Affordable Care Act. Public law 111-148.(Available at:)https://www.govinfo.gov/app/details/PLAW-111publ148/PLAW-111publ148Date accessed: April 6, 2020
- Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure.JAMA. 2010; 5: 1716-1722
- Opinions on the Hospital Readmission Reduction Program: Results of a national survey of hospital leaders.Am J Manag Care. 2016; 22: e287-e294
- June 2016 Report to the congress: Medicare and the health care delivery system.(Available at:)
- March 2015 Report to the Congress: Medicare’s post-acute care: Trends and ways to rationalize payments.(Available at:)
- Engineering, Medicine.Variation in Health Care Spending: Target Decision Making. Not Geography, Washington, DC2013: 23-124
- Implementing the IMPACT Act: 2017 Status Update & Activities.(Available at:)https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-02-23-IMPACT-Presentation.pdfDate accessed: June 25, 2018
- Bundled payments for care improvement (BPCI) initiative: General information.(Available at:)http://innovation.cms.gov/initiatives/bundled-payments/Date accessed: April 5, 2018
- Medicare’s Bundled Payments for Care Improvement (BPCI) Initiative: Expanding enrollment suggests potential for large impact.Am J Manag Care. 2015; 21: 814-820
- The relative importance of post-acute care and readmissions for post-discharge spending.Health Serv Res. 2016; 51: 1919-1938
- 2016 Condition-specific measures updates and specifications report hospital-level 30-day risk-standardized readmission measures.(Available at:)http://aann.org/uploads/Condition_Specific_Readmission_Measures.pdfDate accessed: May 3, 2017
- 2016 Procedure-specific measures updates and specifications report hospital-level 30-day risk-standardized readmission measures.(Available at:)http://aann.org/uploads/Condition_Specific_Readmission_Measures.pdfDate accessed: May 3, 2017
- Condition Category/ICD-9-CM/ICD-10-CM Crosswalks.(Available at:)https://www.qualitynet.org/dcs/ContentServer?c=Page&pagename=QnetPublic%2FPage%2FQnetTier4&cid=1219069856694Date accessed: July 31, 2017
- Is profit status of inpatient rehabilitation facilities independently associated with 30-day unplanned hospital readmission for Medicare beneficiaries?.Arch Phys Med Rehabil. 2018; 99: 598-602.e2
- Reducing readmissions: nurse-driven interventions in the transition of care from the hospital.Worldviews Evid Based Nurs. 2017; 14: 432-439
- Evaluating whether changes in utilization of hospital outpatient services contributed to lower Medicare readmission rate.Medicare Medicaid Res Rev. 2014; 4: E1-E13
- Risk adjustment for socioeconomic status or other sociodemographic factors. July 2 2014 Technical Report.(Available at:)http://www.qualityforum.org/Projects/n-r/Risk_Adjustment_and_Socioeconomic_Status/Draft_Report_for_CSAC_Review.aspxDate accessed: March 27, 2015
- Social risk adjustment of quality measures for diabetes and cardiovascular disease in a commercially insured US population.JAMA Netw Open. 2019; 1: e190838
- Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. Public law 113-185.(Available at:)https://www.congress.gov/113/plaws/publ185/PLAW-113publ185.pdfDate accessed: April 6, 2020
Article info
Publication history
Published online: July 10, 2020
Footnotes
This study was funded, in part, by the National Institute on Disability and Rehabilitation Research (NIDILRR) (90AR5009, 90IF0071), the National Institutes of Health (R01HD069443, K01HD086290, P2CHD065702, K01HD101589), and the Claude D. Pepper Older Americans Independence Center Award at the University of Texas Medical Branch, funded by the National Institute on Aging (P30-AG024832).
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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