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

Buxbaum, Jason; Lindenauer, Peter K.; Cooke, Colin R.; Nuliyalu, Ushapoorna; Ryan, Andrew M.

doi:10.1111/1475-6773.13207

Cited by 5 publications

(6 citation statements)

References 14 publications

(30 reference statements)

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“…As the first large study to explore health-related outcomes of LD patients beyond 2 years, this work offers insights into the longer-term health outcomes potentially associated with LD. The 30-day all-cause readmission rate of 16.2% is similar to published 30-day readmission rates for pneumonia [ 19 ]. This substantiates that outcomes from this study may be comparable to outcomes for patients in other healthcare systems.…”

Section: Discussionsupporting

confidence: 80%

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Health after Legionnaires' disease: A description of hospitalizations up to 5 years after Legionella pneumonia

et al. 2021

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Background and objectives Research on Legionnaires’ Disease (LD) suggests there may be long-term health complications, but data are limited. This study investigated whether Intensive Care Unit (ICU) admission during LD hospitalization may be associated with adverse health outcomes and characterized subsequent discharge diagnoses in patients with LD up to 5 years post-LD. Methods We conducted a retrospective case series study with follow up for 5 years among patients hospitalized at a Department of Veterans Affairs (VA) Medical Center between 2005 and 2010 with LD. Data were collected from medical records on health history, LD severity (including ICU admission), and discharge diagnoses for 5 years post-LD or until death. We used ordinal logistic regression to explore associations between ICU admission and hospitalizations post-LD. Frequency counts were used to determine the most prevalent discharge diagnoses in the 5 years post-LD. Results For the 292 patients with laboratory-confirmed LD, those admitted to the ICU during LD hospitalization were more likely to have a greater number of hospitalizations within 5 years compared to non-ICU patients (ORHosp 1.92 CI95% 1.25, 2.95). Fifty-five percent (161/292) had ≥ 1 hospitalization within 5 years post-LD. After accounting for pre-existing diagnosis codes in patients with at least one hospitalization in the 2 years prior to LD (n = 77/161 patients, 47.8%), three of the four most frequent new diagnoses in the 5 years post-LD were non-chronic conditions: acute renal failure (n = 22, 28.6%), acute respiratory failure (n = 17, 22.1%) and unspecified pneumonia (n = 15, 19.5%). Conclusions Our findings indicate that LD requiring ICU admission is associated with more subsequent hospitalizations, a factor that could contribute to poorer future health for people with severe LD. In addition to chronic conditions prevalent in this study population, we found new diagnoses in the 5-year post-LD period including acute renal failure. With LD incidence increasing, more research is needed to understand conditions and factors that influence long term health after LD.

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Section: Discussionsupporting

confidence: 80%

“…30-day all-cause readmission rate of 16.2% is similar to published 30-day readmission rates for pneumonia [19]. This substantiates that outcomes from this study may be comparable to outcomes for patients in other healthcare systems.…”

Section: Plos Onesupporting

confidence: 85%

Health after Legionnaires' disease: A description of hospitalizations up to 5 years after Legionella pneumonia

et al. 2021

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“…Some literature raised concerns that coding practices have changed (i.e., sepsis or respiratory failure is reported in the principal position rather than pneumonia) to avoid penalties from the Centers for Medicare and Medicaid Services through the Hospital Readmission Reduction Program [ 15 ] and/or due to higher payments for sepsis-related diagnoses [ 54 – 58 ]. However, other studies have not shown changes in coding to be a clear driver of reduced hospital readmissions for pneumonia [ 59 ]. Additional potential explanations for the increasing trend in sepsis-related hospitalizations include the rapid expansion of the Medicare population as the U.S. population ages or increased awareness, changes in screening, and decreased diagnostic thresholds for sepsis [ 4 , 53 ].…”

Section: Discussionmentioning

confidence: 99%

“…related diagnoses [54][55][56][57][58]. However, other studies have not shown changes in coding to be a clear driver of reduced hospital readmissions for pneumonia [59]. Additional potential explanations for the increasing trend in sepsis-related hospitalizations include the rapid expansion of the Medicare population as the U.S. population ages or increased awareness, changes in screening, and decreased diagnostic thresholds for sepsis [4,53].…”

Section: Plos Onementioning

confidence: 99%

Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis

et al. 2022

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Background Pneumonia and sepsis are among the most common causes of hospitalization in the United States and often result in discharges to a skilled nursing facility (SNF) for rehabilitation. We described the timing and most common causes of 30-day unplanned hospital readmission following an index hospitalization for pneumonia or sepsis. Methods and findings This national retrospective cohort study included adults ≥65 years who were hospitalized for pneumonia or sepsis and were discharged to a SNF between July 1, 2012 and July 4, 2015. We quantified the ten most common 30-day unplanned readmission diagnoses and estimated the daily risk of first unplanned rehospitalization for four causes of readmission (circulatory, infectious, respiratory, and genitourinary). The index hospitalization was pneumonia for 92,153 SNF stays and sepsis for 452,254 SNF stays. Of these SNF stays, 20.9% and 25.9%, respectively, resulted in a 30-day unplanned readmission. Overall, septicemia was the single most common readmission diagnosis for residents with an index hospitalization for pneumonia (16.7% of 30-day readmissions) and sepsis (22.4% of 30-day readmissions). The mean time to unplanned readmission was approximately 14 days overall. Respiratory causes displayed the highest daily risk of rehospitalization following index hospitalizations for pneumonia, while circulatory and infectious causes had the highest daily risk of rehospitalization following index hospitalizations for sepsis. The day of highest risk for readmission occurred within two weeks of the index hospitalization discharge, but the readmission risk persisted across the 30-day follow-up. Conclusion Among older adults discharged to SNFs following a hospitalization for pneumonia or sepsis, hospital readmissions for infectious, circulatory, respiratory, and genitourinary causes occurred frequently throughout the 30-day post-discharge period. Our data suggests further study is needed, perhaps on the value of closer monitoring in SNFs post-hospital discharge and improved communication between hospitals and SNFs, to reduce the risk of potentially preventable hospital readmissions.

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“…For chains and lone-standing hospitals, 70% (226) share an HRR. These numbers are lower estimates of the mixing within HRR as they exclude hospitals that changed their status in the observation period.16 This is the noisiest of our measures as it is a relatively low probability event compared to the other measures we use here.17 Note that in our setting and time period,Buxbaum et al (2019) find "changes in the coding of inpatient pneumonia admissions do not explain readmission reduction following the HRRP"; they also compare explicitly for-profit and other hospitals and find no differential coding behavior between the two types of hospitals.18 Consequently, the significant gap in readmissions translates into penalties, which suggests that there is little bunching at the penalty cutoff. This is perhaps a result of the peer bench-marking embedded in the ERR and penalty status, which is unobserved by the individual hospital(Gupta, 2017;Zhang et al, 2016).19 TableC2presents the covariates in the regressions.20 That is, the quality difference at the average market concentration (HHI = 0.233) versus a fully competitive market (HHI = 0) relative to the raw mean quality difference (7 p.p.…”

mentioning

confidence: 96%

Assessing the quality of public services: For‐profits, chains, and concentration in the hospital market

Kunz,

Propper,

Staub

et al. 2024

Health Economics

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We examine variation in US hospital quality across ownership, chain membership, and market concentration. We propose a new measure of quality derived from penalties imposed on hospitals under the flagship Hospital Readmissions Reduction Program, and use regression models to risk‐adjust for hospital characteristics and county demographics. While the overall association between for‐profit ownership and quality is negative, there is evidence of substantial heterogeneity. The quality of for‐profit relative to non‐profit hospitals declines with increasing market concentration. Moreover, the quality gap is primarily driven by for‐profit chains. While the competition result mirrors earlier findings in the literature, the chain result appears to be new: it suggests that any potential quality gains afforded by chains are mostly realized by not‐for‐profit hospitals.

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

Cited by 5 publications

References 14 publications

Health after Legionnaires' disease: A description of hospitalizations up to 5 years after Legionella pneumonia

Health after Legionnaires' disease: A description of hospitalizations up to 5 years after Legionella pneumonia

Causes and timing of 30-day rehospitalization from skilled nursing facilities after a hospital admission for pneumonia or sepsis

Assessing the quality of public services: For‐profits, chains, and concentration in the hospital market

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