Hospital Readmissions Reduction Program: Intended and Unintended Effects

Abstract

This study examines whether the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excess readmissions for certain conditions, has reduced hospital readmissions and led to unintended consequences. Our analyses of Florida hospital administrative data between 2008 and 2014 find that the HRRP resulted in a reduction in the likelihood of readmissions by 1% to 2% for traditional Medicare (TM) beneficiaries with heart failure, pneumonia, or chronic obstructive pulmonary disease. Readmission rates for Medicare Advantage (MA) beneficiaries and privately insured patients with heart attack and heart failure decreased even more than TM patients with the same target condition (e.g., for heart attack, the likelihood for TM beneficiaries to be remitted is 2.2% higher than MA beneficiaries and 2.3% higher than privately insured patients). We do not find any evidence of cost-shifting, delayed readmission, or selection on discharge disposition or patient income. However, the HRRP reduced the likelihood of Hispanic patients with target conditions being admitted by 2% to 4%.

Impact of hospitals’ Referral Region racial and ethnic diversity on 30-day readmission rates of older adults

“…Our analysis revealed hospitals that serve communities with minority and vulnerable populations, low socioeconomic status, low educational levels, high unemployment rates, and high percentage of Medicare recipients per 100,000 residents have increased readmissions. Current literature also indicates additional community and hospital characteristics (i.e., Medicare, Medicaid, education attainment) impact 30-day readmissions [9,11,12]. While the effect sizes are small (IRR close to 1), but significant [42] this research highlights how hospitals work in silos or as a part of their own health system and may not fully engage with the community.…”

“…However, these calculations do not adjust for the diversity or socioeconomic status of the community in which a hospital resides. This lack of statistical control in the predictive model is problematic for hospitals that primarily serve diverse patients [12,13]. At the hospital level, previous research has consistently indicated hospitals serving minority populations experience higher readmissions for HF, AMI, PN, and diabetes [14,15].…”

“…Many studies have explored the impact of county [12,17], hospital [13,21], and patient characteristics [2,8]individually on hospitals' performance on 30-day readmission for congestive HF, AMI, and PN. However, to our knowledge, no study has explored the impact of community diversity in a hospital referral region (HRR) as it relates to its demographics and racial/ethnic makeup, on a hospital's 30-day readmission rate.…”

Hospital Readmissions Reduction Program Does Not Provide the Right Incentives: Issues and Remedies

“…First, Zuckerman et al (2016), Batt et al (2018b), and Wasfy et al (2017) report that the average readmission rates of Medicare patients have decreased after the introduction of HRRP. However Desai et al (2016), Chen and Grabowski (2019), and Wasfy et al (2017) (among others) show that hospitals with the highest pre-HRRP readmission levels had the greatest improvement. In addition, Mellor et al (2017) and Ziedan (2018) demonstrate (using different identification strategies) that there is a statistically significant decrease in readmission rates only for AMI patients for low-performing hospitals.…”

Readmission after pancreatic resection: causes, costs and cost-effectiveness analysis of high versus low quality hospitals using the Nationwide Readmission Database

“…In addition, outcome and readmission data have been made publically available to guide decision-making and improvements in care. [8][9][10] After the initial success of the program for medical conditions (e.g. myocardial infarction, pneumonia, heart failure), HRRP has continued to expand with the recent inclusion of major surgical procedures.…”