Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions

Desai, Nihar R.; Ross, Joseph S.; Kwon, Ji Young; Herrin, Jeph; Dharmarajan, Kumar; Bernheim, Susannah M.; Krumholz, Harlan M.; Horwitz, Leora I.

doi:10.1001/jama.2016.18533

Cited by 244 publications

(260 citation statements)

References 11 publications

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“…Furthermore, as administrative and clinical data collection become more comprehensive, hospital adherence rates can be adjusted for patient and hospital characteristics to allow for a more fair and accurate comparison between multiple centres that vary by geography, payer mix and patient population. Initiatives such as levying penalties on hospitals for ‘preventable’ readmissions are now increasingly common 8. Though such programmes are not without limitations, the intent behind them is to mitigate hospital factors that can influence adverse outcomes.…”

mentioning

confidence: 99%

Medication adherence: a moving target?

Mathews

2017

Heart

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mentioning

confidence: 99%

Medication adherence: a moving target?

Mathews

2017

Heart

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“…11 On the other hand, the highly targeted HRRP, which focuses only on readmissions, has been associated with a significant drop in readmission rates that was largest at poorly performing hospitals and for targeted conditions. [12][13][14] Another important issue is that of Bteaching to the test,n amely, whether when only a limited number of outcomes are measured, others-which may be equally important to patients and clinicians-are neglected. In the UK program mentioned above, for example, quality measures that were not specifically incented slowed in their improvement.…”

Section: Program Scope (Broad Vs Narrow)mentioning

confidence: 99%

“…The lowest-performing hospitals actually improved more quickly over the first 3 years of the program, but many still received penalties in every program year because they started out far behind the best performers and did not fully catch up. 13,14 Baseline low performers, on the other hand, may benefit the most from improvement opportunities. The purest form of rewarding improvement, evaluating providers against their own historical performance, may give baseline poor performers the best opportunity, assuming that there is Blow-hanging fruit^that can be addressed.…”

Section: Rewarding Improvement or Achievementmentioning

confidence: 99%

Elements of Program Design in Medicare’s Value-based and Alternative Payment Models: a Narrative Review

et al. 2017

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Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope (broad vs. narrow); selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both. We examined and classified current Medicare payment models-the Hospital Readmissions Reduction Program (HRRP), Hospital Value-Based Purchasing Program (HVBP), Hospital-Acquired Conditions Reduction Program (HACRP), Medicare Advantage Quality Star Rating program, Physician Value-Based Payment Modifier (VM) and its successor, the Merit-Based Incentive Payment System (MIPS), and the Medicare Shared Savings Program (MSSP) on these elements of program design and reviewed the literature to place findings in context. We found that current Medicare payment models vary significantly across each parameter of program design examined. For example, in terms of scope, the HRRP focuses exclusively on riskstandardized excess readmissions and the HACRP on patient safety. In contrast, HVBP includes 21 measures in five domains, including both quality and cost measures. Choices regarding penalties versus bonuses are similarly variable: HRRP and HACRP are penalty-only; HVBP, VM, and MIPS are penalty-orbonus; and the MSSP and MA quality star rating programs are largely bonus-only. Each choice has distinct pros and cons that impact program efficacy. Unfortunately, there are scant data to inform which program design choice is best. While no one approach is clearly superior to another, the variability contained within these programs provides an important opportunity for Medicare and others to learn from these undertakings and to use that knowledge to inform future policymaking. Take-Home Points • Increasing emphasis on value in health care has spurred the development of value-based and alternative payment models. Inherent in these models are choices around program scope; selecting absolute or relative performance targets; rewarding improvement, achievement, or both; and offering penalties, rewards, or both.• We examined current Medicare value-based and alternative payment models on these elements of program design and found that while current models vary significantly across each parameter, there are scant prior data to inform which choice is best.• Such variability in program design may represent an important opportunity to learn from existing models and create new ones in the future.

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“…After the passage of HRRP as part of health reform in 2010, large analyses of administrative data have shown that readmission rates after AMI decreased faster than they had been decreasing before the law 4, 5, 6. Because distinguishing these types of different patients with AMI is difficult from administrative data, it is not known what specific tactics have reduced readmissions or could further improve performance in the future.…”

Section: Introductionmentioning

confidence: 99%

Clinical Profile of Acute Myocardial Infarction Patients Included in the Hospital Readmissions Reduction Program

Martin

Januzzi

Thompson

et al. 2018

JAHA

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BackgroundMedicare's Hospital Readmissions Reduction Program assesses financial penalties to hospitals based on risk‐standardized readmission rates after specific episodes of care, including acute myocardial infarction. Detailed information about the type of patients included in the penalty is unknown.Methods and ResultsStarting with administrative data from Medicare, we conducted physician‐adjudicated chart reviews of all patients considered 30‐day readmissions after acute myocardial infarction from July 2012 to June 2015. Of 197 readmissions, 68 (34.5%) received percutaneous coronary intervention and 18 (9.1%) underwent coronary artery bypass grafting on index hospitalization. The remaining 111 patients did not receive any intervention. Of the 197 patients, 56 patients (28.4%) were considered too high risk for invasive management, 23 (11.7%) had nonobstructive coronary artery disease on diagnostic catheterization and therefore no indication for revascularization, 19 patients had a type II myocardial infarction (9.6%) for which noninvasive, outpatient workup was recommended, and 13 (6.6%) declined further care. The most common readmission diagnoses were cardiac causes and noncardiac chest discomfort, infection, and gastrointestinal bleeding.ConclusionsOur results demonstrate that more than a quarter of the patients included in the penalty do not receive revascularization either because of provider assessment of risk or patient preference, and nearly one tenth have type II myocardial infarction. As such, administrative codes for prohibitive procedural risk, patient‐initiated “do not resuscitate” status, or type II myocardial infarction may improve the risk‐adjustment of the metric. Furthermore, provider organizations seeking to reduce readmission rates should focus resources on the needs of these patients, such as care coordination, hospice services when requested by patients, and treatment of noncardiac conditions.

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Association Between Hospital Penalty Status Under the Hospital Readmission Reduction Program and Readmission Rates for Target and Nontarget Conditions

Cited by 244 publications

References 11 publications

Medication adherence: a moving target?

Medication adherence: a moving target?

Elements of Program Design in Medicare’s Value-based and Alternative Payment Models: a Narrative Review

Clinical Profile of Acute Myocardial Infarction Patients Included in the Hospital Readmissions Reduction Program

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