Did the Hospital Readmissions Reduction Program Reduce Readmissions? An Assessment of Prior Evidence and New Estimates

Abstract

In this article, we provide a comprehensive, empirical assessment of the hypothesis that the Hospital Readmissions Reduction Program (HRRP) affected hospital readmissions. In doing so, we provide evidence as to the validity of prior empirical approaches used to evaluate the HRRP and we present results from a previously unused approach to study this research question—a regression-kink design. Results of our analysis document that the empirical approaches used in most prior research assessing the efficacy of the HRRP often lack internal validity. Therefore, results from these studies may not be informative about the causal consequences of the HRRP. Results from our regression-kink analysis, which we validate, suggest that the HRRP had little effect on hospital readmissions. This finding contrasts with the results of most prior studies, which report that the HRRP significantly reduced readmissions. Our finding is consistent with conceptual considerations related to the assumptions underlying HRRP penalty: in particular, the difficulty of identifying preventable readmissions, the highly imperfect risk adjustment that affects the penalty determination, and the absence of proven tools to reduce readmissions.

Cheating the Rules of Admission With “Observation”

“…Some studies have suggested that the HRRP has meaningfully reduced readmissions 14,15 ; others have concluded that the reduction in readmissions has been falsely created by changing admissions to observations, which do not count as either an index admission or a readmission. 16,17,18,19,20 Disposition and Inequity There is indirect evidence that the HRRP has contributed to disparities in care and costs for Medicare patients. Significant disparities have been described in admission vs observation decisions, with Black and Hispanic patients being observed more frequently than White patients.…”