IMPORTANCE While telehealth use in surgery has shown to be feasible, telehealth became a major modality of health care delivery during the COVID-19 pandemic.OBJECTIVE To assess patterns of telehealth use across surgical specialties before and during the COVID-19 pandemic.

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Importance Readmissions after surgery lead to poor patient outcomes and increased costs. The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with excess readmissions after specified medical and surgical discharges. Objective To evaluate the effect of this policy on readmissions after major joint surgery (targeted) and procedures with historically high rates not under its purview (non-targeted). Design Using a 20% Medicare sample we performed a retrospective cohort study of patients undergoing one of five major surgeries between January 1, 2006 and November 30, 2014. Setting Population based analysis. Participants Our study included 507,663 patients with targeted (total hip arthroplasty, total knee arthroplasty) and 164,472 patients with non-targeted (abdominal aortic aneurysm repair, colectomy, lung resection) procedures performed at 2,773 hospitals. Exposure Implementation of the HRRP policy. Main Outcomes and Measures We calculated hospital level 30-day risk-adjusted rates of readmission and observation stays using multivariable logistic regression models. Changes in these rates were analyzed for three distinct time periods (Pre-policy (1/1/2006 to 6/30/2010), Performance (7/1/2010 to 6/30/2013), Penalty (7/1/13 to 11/30/14)) corresponding to the HRRP implementation timeline for major joint surgery, using interrupted time series. Results Readmissions for all procedures decreased significantly over the study period. Readmission rates after targeted procedures decreased faster during the Performance period (slope: −0.060, 95% CI: −0.079 to −0.041) compared to the Pre-policy period (slope: −0.012, 95% CI: −0.027 to 0.034, p <0.002). For non-targeted procedures, readmission rates were decreasing during the Pre-policy period (slope: −0.20, 95% CI: −0.24 to −0.16) but stabilized during the Performance period (slope: 0.0084, 95% CI: −0.049 to 0.066, p <0.001). Use of observation stays increased slightly, accounting for 11% of the decrease in readmissions. Conclusions The HRRP effectively decreased readmissions for targeted procedures. There were no associated spillover effects for common non-targeted procedures. A better understanding of differences in impact of the policy across medical and surgical discharges will be necessary to further enhance its effects and generalizability.