Association Between Financial Incentives in Medicare's Hospital Readmissions Reduction Program and Hospital Readmission Performance

Abstract

IMPORTANCE The strongest evidence for the effectiveness of Medicare's Hospital Readmissions Reduction Program (HRRP) involves greater reductions in readmissions for hospitals receiving penalties compared with those not receiving penalties. However, the HRRP penalty is an imperfect measure of hospitals' marginal incentive to avoid a readmission for HRRP-targeted diagnoses. OBJECTIVES To assess the association between hospitals' condition-specific incentives and readmission performance and to examine the responsiveness of hospitals to condition-specific incentives compared with aggregate penalty amounts. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis used Medicare readmissions data from 2823 US short-term acute care hospitals participating in HRRP to compare 3-year (fiscal years 2016-2019) follow-up readmission performance according to tertiles of hospitals' baseline (2016) marginal incentives for each of 5 HRRP-targeted conditions (acute myocardial infarction, heart failure, chronic obstructive pulmonary disease, pneumonia, and hip and/or knee surgery). MAIN OUTCOMES AND MEASURES Linear regression models were used to estimate mean change in follow-up readmission performance, measured using the excess readmissions ratio, with baseline condition-specific incentives and aggregate penalty amounts.

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Association of Postoperative Infections After Fractures With Long-term Income Among Adults

“…Alternative payment models to incentivize patient safety, such as the Centers for Medicare & Medicaid Services’ Hospital Readmissions Reduction Program, have demonstrated positive outcomes. 36 , 37 , 38 However, current readmission penalties are based on treating costs and fail to account for the indirect costs measured in our study. Furthermore, most current reimbursement programs do not apply to patients with fracture, and most postoperative infections in patients with fracture occur beyond the 30-day penalty window, implying that the treating institution’s patient safety responsibility should be extended.…”

AI Models for Predicting Readmission of Pneumonia Patients within 30 Days after Discharge

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