Association of Coded Severity With Readmission Reduction After the Hospital Readmissions Reduction Program

Ibrahim, Andrew M.; Dimick, Justin B.; Sinha, Shashank S.; Hollingsworth, John M.; Nuliyalu, Ushapoorna; Ryan, Andrew M.

doi:10.1001/jamainternmed.2017.6148

Cited by 135 publications

(137 citation statements)

References 5 publications

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“…This would allow for a more granular assessment of this patient population to account for clinical heterogeneity. Otherwise, payment models could unintentionally incentive hospitalize to cherry-pick lower risk patients, a phenomenon that has been described in response to changes in reimbursement (23–25). Although acute gastrointestinal bleeding is often an emergency and patients present to the nearest hospital, if a hospital does not provide services such as advanced endoscopic techniques to evaluate for small bowel bleeding for example, they may transfer patients elsewhere or refer them as an outpatient to a tertiary care center, thereby shifting risk.…”

Section: Discussionmentioning

confidence: 99%

Rates of Hospital Readmission Among Medicare Beneficiaries With Gastrointestinal Bleeding Vary Based on Etiology and Comorbidities

Siddique

Mehta

Neuman

et al. 2019

Clinical Gastroenterology and Hepatology

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In a retrospective analysis of Medicare fee for service beneficiaries hospitalized for gastrointestinal bleeding, we found that 16% of these patients are readmitted to the hospital. Rates of hospital readmission, length of stay, and mortality vary with type of gastrointestinal bleeding, but MS-DRGs account for the largest source of variation. Policies focused on quality and value should account for this heterogeneity.

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Section: Discussionmentioning

confidence: 99%

Rates of Hospital Readmission Among Medicare Beneficiaries With Gastrointestinal Bleeding Vary Based on Etiology and Comorbidities

Siddique

Mehta

Neuman

et al. 2019

Clinical Gastroenterology and Hepatology

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“…The program is expected to penalize hospitals more than $565 million in fiscal year 2019 as a result of excess risk‐adjusted 30‐day readmission rates for six common conditions or procedures . Most evidence suggests that the HRRP has been successful in reducing risk‐adjusted readmission rates for targeted diagnoses …”

Section: Introductionmentioning

confidence: 99%

Changes in coding of pneumonia and impact on the Hospital Readmission Reduction Program

Buxbaum¹,

Lindenauer

Cooke

et al. 2019

Health Services Research

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Objective To evaluate whether changes in diagnosis assignment explain reductions in 30‐day readmission for patients with pneumonia following the Hospital Readmission Reduction Program (HRRP). Data Sources 100 percent MedPAR, 2008‐2015. Study Design Retrospective cohort study of Medicare discharges in HRRP‐eligible hospitals. Outcomes were 30‐day readmission rates for pneumonia under a “narrow” definition (used for the HRRP until October 2015; n = 2 288 644) and a “broad” definition that included certain diagnoses of sepsis and aspiration pneumonia (used since October 2015; n = 3 618 215). We estimated changes in 30‐day readmissions in the pre‐HRRP period (January 2008‐March 2010), the HRRP implementation period (April 2010‐September 2012), and the HRRP penalty period (October 2012‐June 2015). Principal Findings Under the narrow definition, adjusted annual readmission rates changed by +0.07 percentage points (pp) during the pre‐HRRP period (95% CI: −0.03 pp, +0.18 pp), −1.07 pp during HRRP implementation (95% CI: −1.15 pp, −0.99 pp), and −0.09 pp during the penalty period (95% CI: −0.18 pp, −0.00 pp). Under the broad definition, 30‐day readmissions changed by +0.21 pp during the pre‐HRRP period (95% CI: +0.12 pp, +0.30 pp), −1.28 pp during HRRP implementation (95% CI: −1.35 pp, −1.21 pp), and −0.09 pp during the penalty period (95% CI: −0.16 pp, −0.02 pp). Conclusions Changes in the coding of inpatient pneumonia admissions do not explain readmission reduction following the HRRP.

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“…The HRRP has saved billions of taxpayer dollars through reimbursement penalties, and hospital readmissions have decreased, although probably to a lesser extent than originally estimated . Ibrahim et al suggest that 63 percent of the apparent reduction in risk‐adjusted readmission rates after HRRP implementation was due to increases in coded severity. This was presumably facilitated by an increase in the allowable Medicare diagnosis codes (1 primary diagnosis plus 24 possible comorbidities vs 1 primary plus 8 possible comorbidities) beginning in January 2011, a change that overlapped with and confounds any longitudinal analyses of Medicare data, including studies of the HRRP .…”

Section: Discussionmentioning

confidence: 99%

“…Both the positive impact and possible unintended negative consequences of the HRRP have been extensively studied and debated. For example, although earlier studies suggested significant reductions in risk‐adjusted readmission rates after HRRP implementation, more recent analyses suggest that a substantial proportion of the putative reduction in risk‐adjusted readmission rates may be accounted for by expansion of available comorbidity codes in January 2011, as well as regression to the mean, especially for programs with the worst baseline results …”

Section: Introductionmentioning

confidence: 99%

The association of hospital teaching intensity with 30‐day postdischarge heart failure readmission and mortality rates

Shahian

Liu

Mort

et al. 2020

Health Services Research

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Objective To investigate risk‐adjusted, 30‐day postdischarge heart failure mortality and readmission rates stratified by hospital teaching intensity. Data Sources and Study Setting A total of 709 221 Medicare fee‐for‐service beneficiaries discharged from 3135 US hospitals between 1/1/2013 and 11/30/2014 with a principal diagnosis of heart failure. Study Design Hospitals were classified as Council of Teaching Hospitals and Health Systems (COTH) major teaching hospitals, non‐COTH teaching hospitals, and nonteaching hospitals. Hospital teaching status was linked with MedPAR patient data and FY2016 Hospital Readmission Reduction Program penalties. Index hospitalization survival probabilities were estimated with hierarchical logistic regression and used to stratify index hospitalization survivors into severity deciles. Decile‐specific models were estimated for 30‐day postdischarge readmission and mortality. Thirty‐day postdischarge outcomes were estimated by teaching intensity and penalty categories. Principal Findings Averaged across deciles, adjusted 30‐day COTH hospital readmission rates were, on a relative scale ([COTH minus nonteaching] ÷ nonteaching), 1.63 percent higher (95% CI: 0.89 percent, 2.25 percent) than at nonteaching hospitals, but their average adjusted 30‐day postdischarge mortality rates were 11.55 percent lower (95% CI: −13.78 percent, −9.37 percent). Penalized COTH hospitals had the highest readmission rates of all categories (23.99 percent [95% CI: 23.50 percent, 24.49 percent]) but the lowest 30‐day postdischarge mortality (8.30 percent [95% CI: 7.99 percent, 8.57 percent] vs 9.84 percent [95% CI: 9.69 percent, 9.99 percent] for nonpenalized, nonteaching hospitals). Conclusions Heart failure readmission penalties disproportionately impact major teaching hospitals and inadequately credit their better postdischarge survival.

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Association of Coded Severity With Readmission Reduction After the Hospital Readmissions Reduction Program

Cited by 135 publications

References 5 publications

Rates of Hospital Readmission Among Medicare Beneficiaries With Gastrointestinal Bleeding Vary Based on Etiology and Comorbidities

Rates of Hospital Readmission Among Medicare Beneficiaries With Gastrointestinal Bleeding Vary Based on Etiology and Comorbidities

Changes in coding of pneumonia and impact on the Hospital Readmission Reduction Program

The association of hospital teaching intensity with 30‐day postdischarge heart failure readmission and mortality rates

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