Medicare's Readmissions-Reduction Program — A Positive Alternative

Berenson, Robert A.; Paulus, Ronald A.; Kalman, Noah S.

doi:10.1056/nejmp1201268

Cited by 202 publications

(151 citation statements)

References 3 publications

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“…At the same time, the Centers for Medicare and Medicaid Services discontinued reimbursing hospitals for the marginal cost of treating certain preventable hospital‐acquired conditions, including VTE after joint arthroplasty surgeries 7. More recently, the Centers for Medicare and Medicaid Services instituted the Hospital Readmissions Reduction Program,8, 9 penalizing hospitals for greater than expected 30‐day readmission rates after certain conditions and procedures. These programs have to date been successful10, 11 and have motivated interest in expanding the Hospital Readmissions Reduction Program to other disorders.…”

Section: Introductionmentioning

confidence: 99%

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Secemsky

Rosenfield

Kennedy

et al. 2018

JAHA

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BackgroundVenous thromboembolism (VTE) is the third leading cause of vascular disease and accounts for $10 billion in annual US healthcare costs. The nationwide burden of 30‐day readmissions after such events has not been comprehensively assessed.Methods and ResultsWe analyzed adults ≥18 years of age with hospitalizations associated with acute VTE between January 1, 2010, and December 31, 2014, in the Nationwide Readmissions Database. International Classification of Disease, Ninth Revision, Clinical Modification (ICD‐9‐ CM) codes were used to identify hospitalizations associated with acute pulmonary embolism or deep vein thrombosis. The primary outcome was the rate of unplanned 30‐day readmission. Hierarchical logistic regression was used to calculate hospital‐specific 30‐day risk‐standardized readmission rates, a marker of healthcare quality. Among 1 176 335 hospitalizations with acute VTE, in‐hospital death occurred in 6.2%. VTE was associated with malignancy in 19.7%, recent surgery in 19.3%, recent trauma in 4.6%, hypercoagulability in 3.3%, and pregnancy in 1.0%. Among survivors to discharge, the 30‐day readmission rate was 17.5%, with no significant difference in rates across study years (17.4%–17.7%; P=0.10 for trend). Major predictors of readmission were malignancy (relative risk, 1.49, 95% confidence interval 1.47‐1.50), Medicaid insurance (relative risk, 1.48, 95% confidence interval 1.46‐1.50), and nonelective index admission (relative risk, 1.31, 95% confidence interval 1.29‐1.33). Top causes of readmission included sepsis (9.6%) and procedural complications (8.1%). Median rehospitalization costs were $9781.7 (interquartile range, $5430.7–$18 784.1), and 8.1% died during readmission. The interquartile range in risk‐standardized readmission rates was 16.6% to 18.3%, suggesting modest interhospital heterogeneity in readmission risk.ConclusionsNearly 1 in 5 patients with acute VTE were readmitted within 30 days. Predictors and causes of readmission were primarily related to patient characteristics and complications from comorbid conditions, whereas healthcare quality had a moderate impact on readmission risk.

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Section: Introductionmentioning

confidence: 99%

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Secemsky

Rosenfield

Kennedy

et al. 2018

JAHA

View full text Add to dashboard Cite

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“…Endorsed by the National Quality Forum, 30-day readmissions are also the focus of healthcare cost and quality initiatives, including the Hospital Readmissions Reduction program. [24][25][26] The purpose of this study was to determine whether hospitals with lower readmission rates were more likely to have higher ratings on Facebook than hospitals with high readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers

et al. 2015

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BACKGROUND: An increasing number of hospitals and health systems utilize social media to allow users to provide feedback and ratings. The correlation between ratings on social media and more conventional hospital quality metrics remains largely unclear, raising concern that healthcare consumers may make decisions on inaccurate or inappropriate information regarding quality. OBJECTIVES: The purpose of this study was to examine the extent to which hospitals utilize social media and whether user-generated metrics on Facebook ® correlate with a Hospital Compare ® metric, specifically 30-day all cause unplanned hospital readmission rates. DESIGN AND PARTICIPANTS: This was a retrospective cross-sectional study conducted among all U.S. hospitals performing outside the confidence interval for the national average on 30-day hospital readmission rates as reported on Hospital Compare. Participants were 315 hospitals performing better than U.S. national rate on 30-day readmissions and 364 hospitals performing worse than the U.S. national rate. MAIN MEASURES:The study analyzed ratings of hospitals on Facebook's five-star rating scale, 30-day readmission rates, and hospital characteristics including beds, teaching status, urban vs. rural location, and ownership type. KEY RESULTS: Hospitals performing better than the national average on 30-day readmissions were more likely to use Facebook than lower-performing hospitals (93.3 % vs. 83.5 %; p < 0.01). The average rating for hospitals with low readmission rates (4.15±0.31) was higher than that for hospitals with higher readmission rates (4.05±0.41, p < 0.01). Major teaching hospitals were 14.3 times more likely to be in the high readmission rate group. A onestar increase in Facebook rating was associated with increased odds of the hospital belonging to the low readmission rate group by a factor of 5.0 (CI: 2.6-10.3, p < 0.01), when controlling for hospital characteristics and Facebook-related variables. CONCLUSIONS: Hospitals with lower rates of 30-day hospital-wide unplanned readmissions have higher ratings on Facebook than hospitals with higher readmission rates. These findings add strength to the concept that aggregate measures of patient satisfaction on social media correlate with more traditionally accepted measures of hospital quality.

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“…Under the Affordable Care Act, the Centers for Medicare and Medicaid Services has implemented financial penalties for hospitals with 30-day rehospitalization rates that are considered excessive. [6][7][8] 5 Systematic reviews have failed to identify any specific strategy or component that has been effective at reducing rehospitalization.…”

Section: Introductionmentioning

confidence: 99%

Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults

et al. 2014

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BACKGROUND: Rehospitalizations within 30 days of discharge are responsible for a large portion of healthcare spending. One approach to preventing rehospitalizations is early follow-up, usually defined as an office visit with a primary care physician within 7 days of discharge-an approach that is being incentivized by health plans. However, evidence regarding its effectiveness is limited. OBJECTIVE: We aimed to determine whether an office visit with a primary care physician within 7 days after discharge is associated with 30-day rehospitalization. DESIGN: This was an observational study set within a randomized trial. PARTICIPANTS: The study included patients age 65 and older receiving care from a multi-specialty group practice and discharged from hospital to home between 26 August 2010 and 25 August 2011. To control for confounding, we identified characteristics of patients and hospital stays that are predictive of rehospitalization, and also developed high-dimensional propensity scores. Analyses used Cox proportional hazards models and took into account varying amounts of opportunity time for office visits. MAIN MEASURES: We looked at 30-day rehospitalizations at any hospital. KEY RESULTS: Of 3,661 patients discharged to home during the study year, 707 (19.3 %) were rehospitalized within 30 days. Patients receiving an office visit within 7 days numbered 1,808 (49.4 %), and of these, 1,000 (27.3 %) were with a primary care physician. In models predicting rehospitalization, stratified on deciles of propensity score and controlling for additional confounders, the hazard ratios associated with office visits with a primary care physician within 7 days were 0.98 (95 % CI 0.80, 1.21); for visits with any physician, the hazard ratio was HR 1.04, (95 % CI 0.87, 1.25). CONCLUSIONS: We found no protective effect for office visits within 7 days. Such visits may need to be specifically focused on a range of issues related to the specific reasons why patients are rehospitalized. It is likely that outpatient visits will need to be set within comprehensive transition programs

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Medicare's Readmissions-Reduction Program — A Positive Alternative

Cited by 202 publications

References 3 publications

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

High Burden of 30‐Day Readmissions After Acute Venous Thromboembolism in the United States

Hospital Evaluations by Social Media: A Comparative Analysis of Facebook Ratings among Performance Outliers

Association of Early Post-Discharge Follow-Up by a Primary Care Physician and 30-Day Rehospitalization Among Older Adults

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