Readmission Rates After Passage of the Hospital Readmissions Reduction Program

Wasfy, Jason H.; Zigler, Corwin; Choirat, Christine; Wang, Yun; Dominici, Francesca; Yeh, Robert W.

doi:10.7326/m16-0185

Cited by 157 publications

(131 citation statements)

References 19 publications

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“…7 Wasfy et al also found that readmission rates for myocardial infarction, heart failure, and pneumonia decreased more rapidly after HRRP's passage, and that improvement was most for hospitals with the lowest baseline performance. 23 Our analysis extends this work by examining the impact of the HRRP on a surgical population, where it appears mechanisms and strategies of readmission reductions may be different.…”

Section: Discussionmentioning

confidence: 73%

National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era

Mehtsun

Papanicolas

Zheng³

et al. 2018

Annals of Surgery

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Word Count: 250 Manuscript Word Count: 2,838Running Head Trends in Surgical Readmission in the HRRP Era Mini-Abstract:In this study, we sought to examine whether surgical readmission rates have declined over the past decade, and whether the Hospital Readmissions Reduction Program (HRRP) has had an influence. Surgical readmission rates have fallen over the past decade, and these declines have increased during the HRRP era.1 Objective: To investigate whether the Hospital Readmissions Reduction Program, a national program that introduced financial penalties for high readmission rates for certain medical conditions, had a "spillover" effect on surgical conditions. Summary Background Data: Over the past decade, there have been multiple national efforts to improve surgical care. Readmission rates are a key metric for assessing surgical quality.Whether surgical readmission rates have declined, and whether the Hospital Readmissions Reduction Program has had an influence is unclear. Methods:Using national Medicare data, we identified patients undergoing a range of procedures over the past decade. We examined whether certain procedures that would be targeted by the HRRP had a differential change in readmissions compared to other procedures. We used an

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Section: Discussionmentioning

confidence: 73%

National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era

Mehtsun

Papanicolas

Zheng³

et al. 2018

Annals of Surgery

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“…This finding aligns well with reports on targeted medical conditions that found similar declines. 9,10,35,36 These findings are not surprising in light of survey data showing 66% of hospital leaders thought HRRP had major impact on system efforts to reduce readmissions. 37 Additionally, our data are consistent with a previous report on targeted medical conditions showing that hospitals concentrated efforts to reduce readmissions for targeted conditions in response to the threat of penalties, as hospitals penalized under the policy decreased readmissions significantly more for targeted conditions than non-targeted ones.…”

Section: Discussionmentioning

confidence: 95%

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

et al. 2018

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Importance Readmissions after surgery lead to poor patient outcomes and increased costs. The Hospital Readmission Reduction Program (HRRP) penalizes hospitals with excess readmissions after specified medical and surgical discharges. Objective To evaluate the effect of this policy on readmissions after major joint surgery (targeted) and procedures with historically high rates not under its purview (non-targeted). Design Using a 20% Medicare sample we performed a retrospective cohort study of patients undergoing one of five major surgeries between January 1, 2006 and November 30, 2014. Setting Population based analysis. Participants Our study included 507,663 patients with targeted (total hip arthroplasty, total knee arthroplasty) and 164,472 patients with non-targeted (abdominal aortic aneurysm repair, colectomy, lung resection) procedures performed at 2,773 hospitals. Exposure Implementation of the HRRP policy. Main Outcomes and Measures We calculated hospital level 30-day risk-adjusted rates of readmission and observation stays using multivariable logistic regression models. Changes in these rates were analyzed for three distinct time periods (Pre-policy (1/1/2006 to 6/30/2010), Performance (7/1/2010 to 6/30/2013), Penalty (7/1/13 to 11/30/14)) corresponding to the HRRP implementation timeline for major joint surgery, using interrupted time series. Results Readmissions for all procedures decreased significantly over the study period. Readmission rates after targeted procedures decreased faster during the Performance period (slope: −0.060, 95% CI: −0.079 to −0.041) compared to the Pre-policy period (slope: −0.012, 95% CI: −0.027 to 0.034, p <0.002). For non-targeted procedures, readmission rates were decreasing during the Pre-policy period (slope: −0.20, 95% CI: −0.24 to −0.16) but stabilized during the Performance period (slope: 0.0084, 95% CI: −0.049 to 0.066, p <0.001). Use of observation stays increased slightly, accounting for 11% of the decrease in readmissions. Conclusions The HRRP effectively decreased readmissions for targeted procedures. There were no associated spillover effects for common non-targeted procedures. A better understanding of differences in impact of the policy across medical and surgical discharges will be necessary to further enhance its effects and generalizability.

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“…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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Readmission Rates After Passage of the Hospital Readmissions Reduction Program

Cited by 157 publications

References 19 publications

National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era

National Trends in Readmission Following Inpatient Surgery in the Hospital Readmissions Reduction Program Era

Association of the Hospital Readmissions Reduction Program With Surgical Readmissions

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

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